Laserfiche WebLink
JUL -24' 001MON) 09:02 RB CONS',TION IN TEL:610 68'82 P. 002 <br /> v <br /> 1. (a) Is there a PH,SEHD contractor's and subcontractor's questionnaire on Hie or enclosed? YESISt NO[I <br /> (b) is the current certificate of worker's compensation Insurance on file? YESn NO[] <br /> Nall <br /> (c) Does the contractor possess a"Ra2ardous substance Removal certification"? <br /> (d) Has everyone on site,Including crxnelbackhos operator,been certified YE NO[) <br /> to work on hazardous waste site In accordance with CCR Title 8? <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YES [ NO` <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[1 YES[1 NO[] If YES, Permit# <br /> 4. H e contractor obtained approval from the local fire department to perform tank cutting?NAIM' NO[] <br /> Is there knowledge or evidence of leakage from the tank(s)andlor piping? (H yes,please explain)YES[] NO <br /> G. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name Hauler Registration#�"tCL <br /> Address <br /> cityE� 7ip � <br /> 7. Decontamination Procedures: <br /> a. WIN tauk(s)and piping be decontaminated prior to removal? YE�( NO[[ <br /> Identify contractor performing decontamination: <br /> Y^Name %0 C KID + 1 S G�J�C�_ � -ry} T% U » C Cil t t '?41r?P.�7 � <br /> VL / <br /> Address 75 N [J t1 .Cly tL;C ZIP S S <br /> `l PkoneNc{ ?-Dq_jY yI0 .3 3 <br /> 33 De be memad to be df decontamination: <br /> d Describe how rtnsate material will be stored onsite prior to manifesting offsite: <br /> e. klnsateHauler and permitted Treatment,Storage&Disposal Faclllty: <br /> rJ,4,-) 7—>e-- <br /> Hauler Name IVEe; OA.tJ C)Lq /Ect��Hauler Registration#; Lf _. <br /> PC) f n ,tet <br /> (�ASI E Address C� 70 City'De I-q " i 9p-SJ' <br /> � L) Phone No.f1 1 ��+'�� <br /> 51 106a 5 pR. - <br /> �e l o ?i53lS�ermitted DisposaFght Q MEQ,A C. E;An3 #3b R 1 M.O j —= 1t 1 +)- T9&i.79 <br /> EH 23 046 (Revised 08113!99) Page 4 <br /> tCva- 1.3z- Y� `fis <br />