Laserfiche WebLink
/20/2006 12:49 2094640138 ENVIRONMENTAL P�CLTH PAGE 04/11 <br /> 1 (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES('f NO(] <br /> (b) Is the current certificate of worker's compenaation'insurance on file? YES NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[(/NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> hazardous waste site in accordance with CCR Title B? YES(]' NO(] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES('r NO[] <br /> 3. Has applicW performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[ ES(] NO[] If YES, Permit# <br /> 4. Has the contractor,obtained approval from the l.oca).hre department to perform tank cutting?NA[W]' S[] NO[] <br /> 5. 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 g CT Hauler Registration# _ <br /> Address ZS��� 1`)R"C$ il-uo Cigar '� Zip1Sp—o <br /> Phone#(��� ff11 ) _ li�15— 1 � lJ <br /> 7. Decontamination Procedures: <br /> A. Will tank(s)and piping be decontaminated prior to removal? YES Cl NO[J <br /> b. Identify contractor performing decontamination: <br /> Name -S O. S �_ y\C*- S,rn•,-a OA <br /> Addresseal 1110. QtAlDt-LS"r. citySfia.(Pyg;4 ZipgV24� <br /> Phone No.(—1 <br /> c Describe method to bepd d For de�or�smination: <br /> �ja S a4 1Gefa9fo <br /> c <br /> d. escribe how rinsate material will be stated onsite onor tmanifesting offsite: <br /> a W <br /> S"a� PaJ Lav tµ « 1/A r <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name��1CAY <br /> 'A A74r4 9w Zon Hauler Registration#`32y'l <br /> Address <br /> Phone No.( f! 00 )�3 Z T �� <br /> Permitted Disposal SiteZNoas-)Aaki L-SfeRVLel�_ og, -77M- e, <br /> ' - <br /> ST <br /> EH 23 046 (Revised 11/21/06) 4 <br />