Laserfiche WebLink
2 <br />3 <br />rJ <br />8. <br />1. (a) Is the current certificate of worker's compensation insurance on file? <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on <br />hazardous waste sites in accordance with CCR Title 8? <br />Has a "Site Health & Safety Plan" for this job site been submitted? <br />YES [A NO [ ] <br />YES [x] NO[] <br />YES [� NO [ ) <br />YES W NO[] <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA [� YES [ ) NO [ ] If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[J NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [�g <br />If tank residual exists, identify transporting hazardous waste hauler. <br />Name George W Lowry, Inc. Hauler Registration # 3844 <br />Address 1249 Woodland Avenue City Modesto Zip 95351 <br />Phone # ( 209 ) 545-8130 <br />Decontamination Procedures: <br />a Will tank(s) and piping be decontaminated prior to removal? YES r) NO [ ] <br />b Identify contractor performing decontamination: <br />Name Terry D. Hamilton <br />Address 1562 Westbrook Court City Modesto Zip 95358 <br />Phone No.( 209 ) 404-7700 <br />C. Describe method to be used for decontamination: <br />Triple rinse UST utilizing Whico (MIN W4405R) 4,000 PSI pressure washer with hot water and detergent <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Rinsate will be stored on-site in 55 -gallon steel D O T drums labeled with Hazardous Materials stickers <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Same as #6 above Haufer Registration # <br />Address City Zip <br />Phone No ( ) <br />Permitted Disposal Site Riverbank Oil Transfer <br />a. Describe the method that will be utilized to purge and/or inert the tank(s)'. <br />30 pounds dry ice per 1,000 -gallon capacity of UST. EC <br />b. TanklPiping Hauier R E <br />Name Same as #7(b) above <br />NOV <br />Address City Zip <br />C <br />Phone No.( ) ENVIRC)NMENTALTH <br />Hauler Registration # (if hauled as hazardous)_ NIA nEPARTMENT <br />EH 23 046 (Revised 712612016) 4 <br />