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1、WORKPLANTEMPLATEFORTHEDECONTAMINATIONOFILLEGALDRUGMANUFACTURINGSITESAworkplanconsistsof4separatedocuments:Generalworkplan,Pre-decontaminationsamplingplan,Post-decontaminationsamplingplan,andFinalreport.Eachdocumentissubmittedattheappropriatestageofthedecontaminationpro
2、ject.Thisisatechnicaldocument.Thedocumentneedstobecomplete,legibleandattachmentsaretobenumberedandreferencedinmaindocument.LocalHealthApproved:YesNoSIGNATUREDATE_____CONTRACTORINFORMATION:ContractorCompanyName:ContractorMailingAddress:ContractorPhone:CopyofDOHCDLContra
3、ctorCertificateSiteSupervisorNameSupervisorDOHCDLCertificationNumberandExpirationDateCopyofDOHCDLSupervisorCertificateWorkerNameWorkerDOHCDLCertificationNumberandExpirationDateCopyofDOHCDLWorkerCertificateIunderstandthatbeforeanypre-decontaminationsamplingand/orcleanup
4、activitiescanbegin,Imustsubmittoandreceivewrittenapprovalofacompletedsamplingand/orworkplanfromLocalHealthStaff.Iunderstandthatbeforeanymodificationstotheapprovedworkplancanbeenacted,ImustsubmittoandreceivewrittenapprovalofthemodificationsfromLocalHealthStaff.Iundersta
5、ndthatuponworkplanapproval,Iwillnotifythelocalhealthstaff24to48hourspriortostartingcleanup.IunderstandthatImustcomplywithallapplicablestateandfederallaws®ulations.Icertifythatthestatementsinthisworkplanaretrueandaccuratetothebestofmyknowledge._______________________
6、__________________________________________________ContractorSignatureDateWorkPlanTemplateRevised05/05/03Page11of11TableofContents(Listcategoriesandrelatedpagenumbers)ContentPage____________________________________________________PROPERTYINFORMATIONPropertyOwnerName:Pro
7、pertyOwnerMailingAddress:PropertyOwnerTelephoneNumber:DecontaminatedProperty’sPhysicalAddress:LegalDescriptionofDecontaminatedProperty(Ifthisisamobilehomeorvehicle,includemake,model,licenseplate#&VIN/ID#):Assessor’sPropertyAccount#/Parcel#:YearHome/Structurewasbuilt:Wr
8、ittendetaileddirectionsforlocatingthepropertyfromthenearestprincipalmarkedroad:______________________________________
