Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontraetor's questionnaire on file or enclosed? YES H/NO[] <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 Certlflcatlon"? YES W NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES(.} NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES NO(J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[] YES JI NO[I If YES, Permit# Nn! fMOGIGA�i�C <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[ql� <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[J NO[te <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name �� Q� a J //,¢ ,,� 9,, Hauler Registration# 3 7 /Y <br /> Address Pe. SOX 310 (/ City bez-H zip9.C3�r <br /> Phone#( 209 ] /^P' 7 3 <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YES[4'NO J J <br /> b. Identify contractor performing decontamination: <br /> 74 <br /> Name 0,9 i, eW' CowIST/�tk.ro ti- A&I <br /> Address city ��� zip 7,5Z0 <br /> Phone No( <br /> C. Describe method to be used for decontamination: <br /> ,a v c wicG9�5DirMo�D o�,4tL R2�rxT— ?�4svrS TF/fiv t✓ict BE <br /> RIA J�r2 &eZV H(411 P2C'E' eE 6✓/YS�E2 /�r0 sJ/rX rsO— <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name 41,7"/G4,✓ 1/,#Z-44V Hauler Registration# 3711 <br /> Address P O . /2r7 x 3LIa City Pn-14/ zip9/� <br /> Phone No.( ) I'?OV — 7:i Z— C/h q5- <br /> Permitted Disposal Site <br /> SPermittedDlaposalSite /A/0/45Z- <br /> x0-14L <br /> EH 23 046 (Revised 10119198) Page 4 <br />