Laserfiche WebLink
1. <br />2. <br />3. <br />4. <br />5. <br />i� <br />7 <br />(a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YESV NO( ] <br />(b) Is the current certificate of worker's compensation insurance on Me? YFS Kl NO [ ] <br />(c) Does the contractor possess a 'Hazardous Substance Removal Certification YES ���)< NO [ ] <br />Has a 'Site Health & Safety Plan' for this job site been submitted? YES NO [ ] <br />Has ap licant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'.' <br />N/A JK YES [ ] NO [I H YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NAX YES[ ] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO* <br />If tank residual exists, identify transporting hazardous waste hauler. <br />Name l.LAnl t_ R7 DkaaLg Hamer Registration # bky3 <br />Address it 212 i I/_ .31 city 04/..._: / iii <br />Phone # ( 51D ) 5-33 d75-0 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name <br />Address <br />Phone P <br />C. Describe method to be used for decontamination: <br />City <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Pinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />YES(] NO X <br />Zip <br />Hauler NameDtfxA-A)Ai Ar Hauler Registration # 2F3 �3 -:S <br />Phone No. ( 31 Q ) A 129 2— <br />Permitted Disposal Site t ]PIC_ksr)m } SIUG <br />Page 4 <br />