Laserfiche WebLink
I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [ I NO DQ <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [ ] NO M <br /> (c) Does the contractor possess a 'Hazardous Substance Remmal CartiLotion*? YES NO I I <br /> 2. Has a 'Site HeaM &Safety Plan' for this job site been submitted? YES [ ] NO pQ <br /> 3. Has applicant performing removal in the City of Tracy obtained a •Gtadmg and Excavation Permit" <br /> N/A [}{] YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval fromthe local fire department to perform tank cutting? NA(4 YES[ I NO[ ] <br /> S. Is there knowledge or evidence of leakage from the tenk(s) and/or pipes (H yes, please explain) YES [ ] NO M <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> Name Refinery Services Haler Registration S 2591 <br /> Address 2651 Walnut Avenue Cit. Signal Hill Zip 90806 <br /> Phone # ( 213 ) 595-7431 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO [K] <br /> b. Identify contractor performing decontamination: <br /> Name N/A <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination <br /> N/A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> N/A <br /> e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name N/A Harder Registration # <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />