Laserfiche WebLink
I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [i] NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [ ] NO [ ] NA,exemp <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Qwtiiicatiou"? YES NO [ ] <br /> 2. Has a *Site Health &Safety Plan' for this job site been submitted? YES k] NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A [A YES I ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local #xre department to perform tank cutting? NAIK] YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage rrom the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> EPA I.D. # CAD9$O$$7418 <br /> Name Evergreen Environmental Sera:ices Hauler Registration # <br /> Address 6880 Smith Ave. City Newark,Ca Zip_ 94 560 <br /> Phone # ( 800 972 5284 <br /> 7. Decoutamhuatition Procedures; <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [id NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name James J. Hoblitzell <br /> Address <br /> P.O. Box 30331 City Stockton' Zip Ca 95213 <br /> Phone No.(__209 _) 943 7793 <br /> C. Describe method to be used for decontamination: <br /> Using high pressure hot water, rinse with non halogenh-, <br /> eva,rs4ate into vacuum truck for disposal, rinse three <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 Evergreen Hauler Registradou # <br /> Address same as # 6 above City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site Evergreen <br /> Page 4 <br />