Laserfiche WebLink
v � <br /> i• (a) Is there a PHS-EHD contractor's questionnaire s 9 malre on file or enclosed? YES [.� NO [ ] <br /> (b) Is the current certificate of worker's compensation Insurance on file? <br /> NO [ ] <br /> (c) Does the contractor possess a 'fr-� <br /> 2. Hasa 'Site Health & Subswwe Removal � �'°�] NO [ 7 <br /> Safd7 Plan' for this job site been submitted? <br /> YES NO [ 7 <br /> 3. Has ap licaut performing removal In the City of Tracy obtained a <br /> N/A YES [ 7 NO [ ] If YES, Permit #—G��/AJ 1y�� n P it'? <br /> 4. Has the contractor obtained approval from the local flre department to <br /> perform tank cutting? NXYES[ 7 NO[ 7 <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, Please explain)) `YES [ ] NO <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> Name? jdLFi �N� RICyGLcAJG C17e fail E/'9G4Q <br /> Registration # D8�8 <br /> Address (3 331 A) . Hw � Z <br /> meq_—� City "Al Zip Oi S l Z <br /> Phone # - <br /> t <br /> 7 Decontamination Promdmrs <br /> i <br /> a. Will tank(s) and piping be decontaminated prior to removal? <br /> YES NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name WQL¢//T FaVOIv20.J AFF S Qt1LGc S <br /> Address s <br /> City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> V,44UL) ✓i -&aDU,4G wk FL1/S/j TAn/r T AT�.P <br /> /{n!n VdGuc,� k rNS4T6 Z.- 76 TAa/lf�C �2uc <br /> d. Describe how rtnsate material will be stored onsite prior to manifesting offsite: <br /> IIIrJSi4Ti 4OZtc /)or 96 57o.tE,Op trrt UA/ 1 �✓/ T2 JG CI <br /> i.JtCC TiQAslS,OareT T!1 Rzclyc4arA) GHC.IC.ITl/ SAME .OA_/ /rt/t�Gi?ATCr <br /> e Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name SAiyl c AS XCezO 6 41300E Hauler Registration # <br /> Address <br /> City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />