Laserfiche WebLink
v � <br /> I. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES NO [ W— <br /> (b) <br /> (b) Is the current certificate of worker's compensation Insurance on tile? YES W NO [ ] <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [t J"" NO [ ] <br /> 2. Iles a 'Site Health &Safety Plan' for this Job site been submitted? YES [vr/NO [ ] <br /> 3. Has applicant performing removal In the City of Tracy obtained a 'Grading and Ricavation Permit'? <br /> N/A [ ] YES [ ] NO ( ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[14 YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from [lie tank(s) and/or piping? (If yes, please explain) YES [ ] NO [� <br /> 6. If tank residual exists, Identify transporting huzardous waste hauler: <br /> Name J�PI\/i A .�z Hauler Registration <br /> Address aas I R=, Nwv 33 city zip -S43 <br /> Phone # <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) anplpl be decontaminated prior to removal? YES [q'-�NO [ I <br /> b. Identify contractor performing decontamination: <br /> Name '�„•�C"�-t-;.� ��c/.4Zy1Uc� v.L Fi,,_ tl.- _ '7 ic- <br /> Ll <br /> Address J- e /-ll�� - city� k�C)A Zip <br /> Phone No.( Ll•— W,33>3 <br /> C. Describe method to be used for decontnga[!!atlon: <br /> d. Describe how rinsate material will be stored onsltoe prior to manifesting offsite: <br /> Sr.A}t"ti[ 4--lets-u— IA"p f&u—<4 atUF1C� <br /> e. Rlnsale Ilauleeer and permitted Treatment, Storage & Disposal Facility: <br /> IIauler Name f::' �/I F�i�pi tl2 Hauler Registration # <br /> Addressf3:53 L No, PiJv -33 city rD�t ire ,csO () zip_ 7 (a3 <br /> Phone No. <br /> Permitted Disposal Site <br /> Page 4 <br />