COMPLIANCE INFO_1998-2006 - Laserfiche WebLink

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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES le( NO [ (b) Is the current certificate of worker's compensation insurance on file? YES DI NO [ (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES,, A' NO (d) Has everyone on site, including crane/backhoe operator, been certified Y111 to work on hazardous waste site in accordance with CCR Title 8? YES'0 NO 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES X NO 3. Has'applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A V4 YES NO If YES, Permit# 1 1%, 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA ZKYES1 NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) R YES NO'W a dwja A IL!6 1&iA og a If tank residual exists, identify transporting hazardous waste hauler: Name NVi F_a\ LNK) \/P -,LLQ` E(\s V 'v?,()N Hauler Registration # -7 4 4: Address city-LL � \ Zip_� 53� Phone # �()Q) 4 & s Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES NO b. Identify contractor performing decontamination: Name S to C J< —W nL S E(SjF-Y_ S7 N7 W N F_Q Address aQ a aL\ Ll N) \ V KX City �77 0 r- 1, 7 0 U - Zip a 520 'S Phone No.(2O S ) � (v 1 t - e _3-3 3 C. Describe method to be used for decontamination: k�Ka Es R N K) =a r-., a � d. Describe how rinsate material will be stored onsite prior to manifesting offsite: i. P. -, F_ L I 21-N e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name NM t_R\ C_P\ I ] !&U_Lz4 IZ-WVMQ�) Hauler Registration # Address o, a, u x 3 N _City -!=,-�1,. -Zip Phone No. ea - 4 6 t i)leL\ s7� T-,\ � P, tL E K\j \ L� C>k L SNL Permitted Disposal Site V7 0 0 �oln 1r\ 1_�\ c -A-1 0 L 1% � A E L : S r ON LfS 5/20 EH 23 046 (Revised 9/11/96) Page 4