Laserfiche WebLink
1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[,J NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES J,J NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESI J NO(] <br /> (d) Has everyone on site,Including crane/backhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YES t) NO[J <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES t] NO(] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[J YES[] NO[] If YES, Permit 0 A(16- <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[I NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[J NO Q9 <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name G S r i KSn&OX( //) Hauler Registration N <br /> Address �Z 11t p",t Qty n ,L(,lynl66ud Zip 192ol <br /> Phone <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? IBS,kj NO[] <br /> b. Identify contractor performing decontamination: <br /> Name F', C_L f C. rlK So f,(Address 2115-5 \���( }j� L4 Qty iii[ h(,t&PxA Zip <br /> Phone NosJ I n ) a35- <br /> C. <br /> 35-c. Describe method to be used for decontamination: <br /> .TaivKs � .Y- ee n-e I Y <br /> o(A r_-E. L. I Q v-4e_cs <br /> d. Describe how timate material will be stored onsite prior to onsite: <br /> e. Rinsate Hauler and permitted Treatment.Storage&Disposal Fadllty: <br /> Hauler Name y J' r-, Kn SC o tii Hooter Registration x 1 3 3 <br /> Address ,'] �/A/l �"` v� Qty (-P-i yn V1A Bp- �tlqa/ <br /> Phone No. / <br /> Permitted Disposal Site �(j/[/[ La v U YV A�tq Y)j''1 W, <br /> EH 23 046 (Revised 10119198) Page 4 <br />