Laserfiche WebLink
1 [ I <br /> (a) Is There ■ PI-18-01D contractor's questionnaire on I1ie or enclosed? 7tFS E)q No <br /> (b) is the current certificate of worker's compensation Insurance on file? <br /> yFs [X1 No [ � <br /> (c) Does the contractor possess a 'Hazardous Substance Removal C M-MCatlon"? YES [19 NO [ 1 <br /> 2. Iles a 'site Health & safety Pisa' for this Job site been submitted? <br /> YFS [xl NoE1 <br />' 3. (les applicant performing removal In the City of Tracy obtained a 'Grading and Esamrstlon Permit'? <br /> N/A tq YES E I NO [ I U YES, Permit # <br /> 4. Iles the contractor obtained approval from the local Fire department to perform tank cutting? NAPS YES[ I NO[ ) <br /> 1 S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ l NO <br /> 5. If tank residual eidats, Identify transporting hazardous waste haulers <br />' Now Ui Waste oil hauler IIsuler Reghd talon #CAD 982417255 <br /> Address City Denairf Ca. Zip 95316 <br /> t0 <br /> Phone* (�� 33 L437 <br /> UecontamInatlost P'rocednresr <br /> a, Will tank(s) and piping be decontaminated prior to removaF7 NO [ I <br /> YES [ <br /> b. Identify contractor performing decontaminatlons <br /> Name Jim Thorpe Oil, Inc./ DESA Rich-Mart Construction <br />' <br /> Address 351 N Beclunan lid. City Lodi Zip 95240 <br />' Phone No. z( 368-6175 / 462--4581 <br /> C. Describe method to be used for decontaminations hi ion. <br />' rth !11esiduals. <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offslter <br />' Rinsate will be stored in i 11 <br /> e sealed and labeled until <br /> Rinsete Hauler and permitted Treatment, Storage do Disposal Facllityt <br /> Hauler Name No IlaWer Registration # CAD 89 241'L255 <br /> Address City Denair, ZIP 95316 <br /> Phone No. ( 20g13-32-0 10 <br /> Permitted Disposal Site <br /> Refiner, Patterson Ca. or of er cality. <br /> Page 4 <br />