Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YESkp NO[] <br /> (b) is the current certificate o1 worker's compensation Insurance on file? YES,4 NO[I <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YE$J$ NO[J <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified YE3�{. NO[J <br /> to work on hazardous waste site In accordance with CCR Title 87 <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES)4 NO[1 <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? / <br /> NIA YES[J NO[J if YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NANYES[J NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[J NO 14 <br /> 6, if tank residual//e►►xistts,I�Ide��ntify transporting hazardous waste hauler. <br /> Xt (ua�iaoNNENnA✓ Hauler Registratlon# � <br /> Name � <br /> A <br /> (� fs <br /> Address L O� �' V$LFIGO (-0 City—:11T�e-q Zip <br /> Phone#( j!?6VV ) <br /> ?. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES?, NO[] <br /> b. Identify contractor performing decontamination: <br /> Name RS{'1' �iK�I I N rG�i�l►`(Et <br /> Address <br /> ?}Afo (b wfi P-oRD city 1969 71p �I cb b0 I <br /> Phone No S( 30 J <br /> c. <br /> DescribeTZ-methodk � Wbe useTZ-drJ�decontaminE=L "atl W� P t K G1 <br /> d. Describe how rinsate mate will be stored`prior t� omanifesting sItte: a <br /> Tyl KSt[fT� l O.&r <br /> L IZ— t S Pc;k <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name At5e, � "%II"r1H�'r,,v HaulerReglstration# 001J <br /> Address 14X70- ✓�G0 12b _City I'Zft('`T Zip <br /> Phone No.('600 ) pa33 Otlo <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 08113199) Page 4 <br />