REMOVAL_2002 TEMP CLOSURE - Laserfiche WebLink

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i 1. (a) Is there a PHS ERD contractor's and subcontractor's questionnaire on file or enclosed? YES H NO[) (b) Is the current certificate of worker's compensation Insurance on Me? YES K NO[J (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES 1;1. NO[J (d) Has everyone on site,including cranelbackhoe operator,been certified to work on hazardous waste site in accordance with CCR Title 8? YES K N01 J 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES¢], NO[] 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? NIA 14 YES[J NO[) If YES, Permit M 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N41 YES(J NO(J 5. is there knowledge or evidence of leakage from the tanks)and/or piping? Of yes,please explain)YES[J NO 6. If tank residual exists,Identify transporting hazardous waste hauler. t)VX,.,orsa.l CC<�tCAOR&3652212 Name yi�t-or,MGlLTr].zl Hauler Address 910 In7f)y5T(\eJ GLi city zip q is,G) Phone N( 70? ) ��t? 664A 7. Decontamination Procedures: a. Will tanks)and piping be decontaminated prior to removal? YES K NO[] b. Identify contractor performing decontamination: Name �\'1tJL/5GL1 L/Ivi20r'tv„�✓��-! Address t41 D 1 tA.Ov5 rr,4 WL4 city &-el,elm zip 9451y Phone No.( 7'41 6CAq C. Describe method to be used for decontamination: ,JAAlr_� w\1k 6e_ AtjVS* JuSll�horwaterarrss�� tJuc � td�krcdnt. P,nsam g0G5 TD Rorh.c. EL Describe bow rlusate material will be stored onsite prior to manifesting offsite: IN %Q.LVIh'1'1 ,k: 4 f Same- 6614 n PP- 'Wa 1- e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility. hh Hauler Name �J n l vt r sal Z nv\R0J�It'7a't-fG.l Harder ReglstrIttion I Address q M I.voys'rrtwl Wen4 City 'etite-IG Zip 14510 Phone No.( 7qq 6699 Permitted Disposal Site WI1n\(, G/\Vl(Zp/L✓rLL/l'1't?vl EH 23 046 (Revised 08113199) Page 4