Laserfiche WebLink
E <br />1. (a) Is there a PHS con is and sabcon is questionnaire on rile or enclosed? YE NO [ ] <br />(b) Is the current certificate of worker's compensation Insurance on rile? YE NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YE NO [ j <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YEgg NO ( ] <br />2. Has a "Site Health & Safety " for this job site been submitted? YES NO [ ] <br />3. <br />HP <br />Hcant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA YES [ ] NO [ J If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? YES[ I NO[ ] <br />5. Is there knowledge or evidence of leakage from the s) and/or piping? (If yes, please explain) YES [ ] N0 <br />6. If tank residual exIsU, identify transporting hazardous waste hauler: <br />ddre , L <br />Decontamination Procedures: <br />a. will s) and piping be decontaminated prior to removal? YES [ ] NO ( ] <br />b. Identify contractor performing decontamination: <br />Name S i c) C S� —TQU S FcR� L C L �� P1 i l 0 ► ►� C� V \ I`� ' N C vM \a iat\iy 1 N �, <br />Address $y 8 1 \ i\ 4 \ c� R\ City S-" C b L� \700 Zip �j SP DS <br />Phone No.(?—b(�, ) 464 - 33 3 <br />e. Describe method to be used for decontamination: <br />191 h7CZ \NSN� � <br />d. Describe how dnsate material will be stored onsite prior to manifesting offsite: <br />e. Rftute Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Namej�,������--�m7L Hauler Registration # <br />idr it - Zip <br />♦ r <br />Phone No. <br />\NZ�.USiZ�P\L �aRU\C�z. O\L \NL. <br />Permitted Disposal Site S Q u i N Sb —� o L.n C&ASN C.G L k S c N -� 002 5 <br />EH 23 046 (Revised 10119198) Page 4 <br />