Laserfiche WebLink
1, (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES UdNO [ <br />(b) Is the current certificate of worker's compensation insurance on file? YES M NO [ <br />(c) Does the contractor possess a 'Hazardous Substance Removal Certification"' YES [k, NO [ ] <br />2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES <br />NO [ ] <br />3, Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br />NIA U YES [ ] NO [ ] If YES, Permit # <br />4, Has the contractor obtained approval from the local fire department to perform tank cutting? NAQd YES[ l NO[ ] <br />bi <br />Is there knowledge or evidence of leakage from the tans) and/or piping? (If yes, please explain) YES [ ] NO <br />k <br />6. If tank residual exists, identify transporting hazardous waste hauler. , <br />Name <br />Hauler Registration # <br />City Zip <br />Address <br />G ^ _L . ,a,rt? Z'1 1 <br />C-1Phone # <br />7. Decontamination procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES <br />Cq NO ( ] <br />b, Identify contractor performing decontamination: <br />Name Al <br />i �'y. City Zip �`'i <br />Address 31 L.->0 -- <br />Phone No.( !l 1 1-i� " - `4 <br />C. Describe method to be used for decontamination: <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 />��� i 1� < '�' ' r� G <br />Hauler Registration # <br />Hauler Name 1 <br />Address 3 ) ©1 <br />cityt ' Zip <br />Phone No. <br />Permitted Disposal Site <br />.Scar -r-. <br />Page 4 <br />