Laserfiche WebLink
(a) Is there a PHS- EED contractor's questionnaire on rile or enclosed? <br />YES )4 NO <br />compensation insurance on rile? YES <br />NO I I <br />,I <br />(b) Is the current certificate of worker's co <br />ess a 'EUtzardous Substance Removal Certification- YES NO <br />(c) Does the contractor poss YES 'c 1, NO <br />2. Has a Site Health & Safety Plan* for this job site been submitted? K <br />3. Has applicant performing removal in the City of Tracy obtained a *Grading and Excavation Permin <br />N/A>4 YES I I NO H If YES, Permit # I ru <br />perform tank cutting? NA ' YES( I NO( I <br />4. Has the contractor obtained approval from the local fire department to . �A <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 />Hauler Registration <br />Name <br />Zip v-3 city <br />Address—zc= <br />Phone # Lll! O <br />7. Decontamination Procedures: YES NO <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name <br />Address city zip <br />Phone No.( <br />-!a1 0 - -3 <br />C. Describe method to be used for decontamination: <br />e- <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 Hauler Registration <br />Address _I ',4 city Ike rY. or.�zip <br />1 -3 Ci --3 <br />Phone No. <br />Permitted Disposal Sit <br />Page 4 <br />