REMOVAL_1998 - Laserfiche WebLink

Home Browse Search

• • 1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES �K NO [ I (b) Is the current certificate of worker's compensation insurance on file? YES NO [ I (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES NO [ ] (d) Has everyone on site, including cranelbackhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES NO [ ] 2. Has a "Site Health & Safety Plan" for this job site been submitted? NO M 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A M YES [ I NO [ I If YES, Permit # -- 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAN YES[ ] NO[ } 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO ([ 6. If tank residual exists, identify transporting hazardous waste hauler: Name_ �eile hire. EMVift71'IYY12C l Hauler Rrgist�ration # 2`�`� Address Z5422- Tralnuco 2t"ts City Fore Zip X42 34 Phone # !± -) 45n-1010 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ ] b. Identify contractor performing decontamination: G d. e. Name et'S Cor22r Yib Address ilia! E. `o rj R?a City LQ2eh Zip 10 506 Phone No.(5 ?- ) Describe method to be used for decontamination: Describe how rinsate material will be stored onsite prior to manifesting offsite: J,,obi2G9ii in C;)!5aQll. drone labelad �c.Gardi 1 r Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name til 5f irt✓° �nV►t' �� Hauler Registration # Address 2GjA•ZZ IrPbu IC� City L k. For zip Z 3© Pho,e No. ( :Z I+ 4-r24 - 1C )1 C) Permitted Disposal Site en erL'�oon OI] GA iO S�7- 71o0 5/20 EH 23 046 (Revised 9/11196) Page 4 on-ke-)