Laserfiche WebLink
1. <br />2. <br />3. <br />4. <br />5. <br />(a) Is there a PHS - c ontractoes questionnaire on file or enclosed? YES NO [ ] <br />(b) Is the current certiffeate of worker's compensation insurance on file? YES NO [ ] <br />(c) Does the contractor possess a on"? YES [i,Y NO [ ] <br />Has a 'Site Health & Safety Plan! for this job site been submitted? YES ANO [ ] <br />Has applicant performing removal in the City of Tracy obtained a 'Grading and Ekeavation Permit" <br />N/A 14 YES [ ] NO [ ] If YES, Permit <br />Has the contractor obtained approval from. the local fire department to perform tank cutting? NA U4 -'IM ( ] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO tj-- ' <br />6. If tank residual exists, identify transporting hazardous waste hauler. <br />Name Evuy� u :2v.v,--ion # 001�t <br />Address 2 � �� �G � C � � A Cit9,Zip QjLv <br />R <br />Phone #S -/L 235 - 1 :3G 3 <br />a. Will tank(s) and piping be decontaminated prior to removal? YES[ ] NO [ice <br />b. Identify contractor performing decontamination: <br />Name 0 k <br />Address City Zip <br />Phone No.( ) <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 permined Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />Address City Zip <br />Phone No. ( ) <br />Permitted Disposal Site <br />