Local Education Agency State Project No. Phase School Architect Date DAS - OFFICE OF SCHOOL CONSTRUCTION GRANTS & REVIEW (OSCG&R) PLAN REVIEW CHECKLIST STAND-ALONE POLYCHLORINATED BIPHENYLS (PCB’S) ABATEMENT AND MANAGEMENT PLAN FORM SCG-3012 Project Scope), or explain condition. Do not use Not Applicable (N/A). Use “None”, “NPS” (Not in Submit completed with this completed form. Pre-Bid Conformance Review (PCR) Checklist Status column (by SCG staff): Accepted Open Item PCB Abatement Plan Preparer: ___________________________________ Drawings Specifications Status Type(s) and amount(s) of PCB’s to be abated per 01. Drawings / Specifications If a Self-Implementing Plan (SIP) is being prepared, notification of PCB work/SIP to USEPA 02. (>50 ppm PCB- containing materials) If <50 ppm PCB-containing materials, notification 03. of PCB remediation work to DEEP Proper worker protection (OSHA req.) 04. 05. Pre-abatement meeting 06. All PCB locations identified Employees' decontamination system 07. Remediation methods 08. Decontamination and cleaning procedures for 09. PCB work areas Waste disposal system (PCB removal from 10. contaminated area) Proper worksite preparation 11. Verification testing (performance based or SIP) 12. and re-occupancy clearance standards Replacement materials specified 13. If a SIP were prepared and submitted to EPA, include copy of EPA approval and any 14. conditions
Local Education Agency State Project No. Phase School Architect Date DAS - OFFICE OF SCHOOL CONSTRUCTION GRANTS & REVIEW (OSCG&R) PLAN REVIEW CHECKLIST STAND-ALONE POLYCHLORINATED BIPHENYLS (PCB’S) ABATEMENT AND MANAGEMENT PLAN FORM SCG-3012 Do not use Not Applicable (N/A). Use “None”, “NPS” (Not in Project Scope), or explain condition. Submit completed Pre-Bid Conformance Review (PCR) Checklist with this completed form. Status column (by SCG staff): Accepted Open Item PCB Abatement Plan Preparer: ___________________________________ Status Drawings Specifications 01. Type(s) and amount(s) of PCB’s to be abated per Drawings / Specifications 02. If a Self-Implementing Plan (SIP) is being prepared, notification of PCB work/SIP to USEPA (>50 ppm PCB- containing materials) 03. If <50 ppm PCB-containing materials, notification of PCB remediation work to DEEP 04. Proper worker protection (OSHA req.) 05. Pre-abatement meeting 06. All PCB locations identified 07. Employees' decontamination system 08. Remediation methods 09. Decontamination and cleaning procedures for PCB work areas 10. Waste disposal system (PCB removal from contaminated area) 11. Proper worksite preparation 12. Verification testing (performance based or SIP) and re-occupancy clearance standards 13. Replacement materials specified 14. If a SIP were prepared and submitted to EPA, include copy of EPA approval and any conditions
FORM-SCG-3012-PCB-checklist-5-30-17-KD.docx