Laserfiche WebLink
L (a) Is there a PIIS-EHD contractor's questionnaire on Ne or enclosed? YES NO ( j <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES NO [ I <br /> (c) Does the contractor possess a "Ilazanloos Substance Removal Cerifficstion`f YES NO [ j <br /> 2. Has a 'Site Health A Safety Plan' for flits job site been submitted? YES P( NO ( 1 <br /> J. [ins nppficant perrormlug removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> NIA K YES [ I NO [ ] If YES, Permit M <br /> 4. [las the contractor obtained approval from the local fire department to perform lank culling? NA jq YES[ I NO[ ] <br /> 5. Is (here knowledge or evidence of leakage from the lank(s) and/ plphtg7 (If yes, please explain) YES [ j NO ) <br /> 6. If Innk residual exists, Identify transporting hazardous waste harden <br /> Name Nor-Cat Waste Oi 1 haulers Hauler Registration aR CAI) 902417255 <br /> Address P.O. Box 645City Denair, CA Zip 95316 <br /> Phone # ( 209 ) 332-0710 <br /> 7. Decontamination Procedurex <br /> a. Will tank(s) and piping be decontaminated prior (o removal? YES NO [ ] <br /> b. Idenllfy contractor performing decoulaminallom <br /> Name Jjm "Thorpe Oil , Ltc./ I)OA Rjch-Mart Construction <br /> Address 351 N. Beckman Rd./ P.O. Box 357 Clly Lodi CA Zip 95241-0357 <br /> Phone No.( 209 ) 462-4501 J'I'O/HMC Ilaz Mat. hauler A 2667 <br /> C. Describe methodo be s for decontaminaltom <br /> On Pile at 4'115/ 1I) <br /> d. Describe how Ansate material will be stored onslle prior to manifesting offshet <br /> 'Illy, rinseaie will he removed by Jim 'Thorpe Oil Inc personel and placed in <br /> dursns_ 'l'he drums will be transoorted by us to out, yard at 007 Black Diamond <br /> Way, Lodi., CA to await pick up by a qualified collection company. EPA #CAL 000012004 <br /> e. Rlnsale hauler and permitted Treatment, Storage dt Disposal Facidlly: <br /> Hauler Name Same as 11 6 Hauler Regls(ration N <br /> Address Cloy Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site Refineries Services Patterson CA or other approved facility. <br /> Page 4 <br />