Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[I NO[J <br /> (h) Is the current certificate of worker's compensation Insurance on EllYES NO[je? [1 <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[J NO[j <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 87 YES l 1 NO 11 <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YES 11 N'A <br /> 3. Has appllcaut performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[J YES[I NO I I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA(I YES[I NO[1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES([ N01[ <br /> 6. It tank residual exists,Identify transporting hazardous waste hauler. <br /> Name F S. HaulerReglstratlaa/��p�fSZO'J611�j <br /> Address _ — IS`JO city Zip �S�8o ( <br /> Phone 8( 510 1 235 - 3J�I 7J <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESIK N01) <br /> b. Identify contractor performing decontamination: <br /> Name 4s G 'L <br /> Address City enlf,) zip SA So i <br /> Phone No.( 1 Z�7�7—��5•�7 <br /> C. Describe method to be used for decontamination: <br /> 1_1:��=�= •st'. IOOE �-^.�'�I�?�i-E_ 3m? �..a�__k 1-�rl�� Rtr i->t <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offslte: <br /> —Tw,U <br /> e. RinsateHauler and permitted Treatment,Storage&Disposal Facility. e+R1�1.�w— E .c • Z <br /> HawffName l-br9tG Hamar Registration/c_n0Oo9gS2(05 <br /> Address 7-C>8\ VinY Pa. city-E.• P6�, IL.a--Zlp q4'-_'L70•3 <br /> PhoneNo.( 4u5C% j ".JZ-A— \ to;5 <br /> Permitted Disposal Site �f_J_C Agr \A. llo� �T• <br /> JI EH 23 046 (Revised 08113199) Page 4 <br />