Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES M NO [ ] <br /> (b) Is the current certificate of worker's compensation Insurance on tile? NA YES I ] NO ( ] <br /> (c) Does the contractor possess a 'Hazardous Substance Resaval Certitiation'Y YES [XI NO [ ] <br /> 2. Has a 'Site Health &Safety Piano for this job site been submitted? YES X4 NO ( ] <br /> 3. Has applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit"? <br /> N/A [,4 YES ( 1 NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local lire department to perform tank cutting? NAM YES[ I NO[ ] <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 ENVIROPUR (WEST hauler Registration # 2591 <br /> Address13331 IV. HIGHWAY 33 City PATTFRSON Zip 95563 <br /> Phone # ( 80U ) 874 4444 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [)I NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name JmFS HORI TT7FI I <br /> Address Box 30331 City STOCKTON Zip 95213-0331 <br /> Phone No.( 20q T _945 7793 <br /> C. Describe method to be used for decontamination: <br /> WATER. NON CHI ORTNATET) rI FANFR ANT) HIGH PRESSURE—cTFANa <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> IT WTI I NOT RF sTT)RFT) ON CTTF. IT WTI : RE IMMEDIATE' V RFW/VD Rv vnriniM TRUCK <br /> AND TRANSPORTED FOR RFrVr1ING Al AN APPROVEL FACILITY <br /> C, Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name FNVIROPI IR 41FSr Hauler Registration # 1491 <br /> Address 13331 N. HIGHWAY 33 City PATTERSON Zip 95363 <br /> Phone No. ( 800 T 874 4444 <br /> Permitted Disposal Site ENVIROPUR WEST <br /> Page 6 <br />