Fillable Pd-supv-form Project Designer/Supervisor/Abatement Worker

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Pd-supv-form Project Designer/Supervisor/Abatement Worker

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The Pd-supv-form Project Designer/Supervisor/Abatement Worker form is 2 pages long and contains:

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  • 17 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

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Project Designer/Supervisor/Abatement Worker
Lead-Based Paint Activity Quarterly Report
Instructions:
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Project Designer/Supervisor
Lead-Based Paint Activity Quarterly Report
__ No Lead-Based Paint Activity performed this quarter.
Note: Choose a report quarter. A separate repot required for each quarter
Please e-mail to Shaun-west@cherokee.org or mail to Cherokee Nation, Environmental Programs, P.O. Box 948, Tahlequah, OK 74465
Project Designer/Supervisor Name:__________________________________ Certification #: ________________________ Date:___________________
Property Information
Activity Date
Abatement Workers
(list of workers that worked on property)
Abatement Type
(check all that apply)
Date Built (Do not use unknown):___________
Address:_______________________________
City:__________________________________
Zip:___________________________________
S
tart Date:__________
S
top Date:__________
Name: Certification Number:
1.)__________________ 1.)_________________________
2.)__________________ 2.)_________________________
3.)__________________ 3.)_________________________
4,)__________________ 4.)_________________________
___Interior Abatement
___Exterior Abatement
___Soil Abatement
___Other:
___________________________
Date Built (Do not use unknown):___________
Address:_______________________________
City:__________________________________
Zip:___________________________________
S
tart Date:__________
S
top Date:__________
Name: Certification Number:
1.)__________________ 1.)_________________________
2.)__________________ 2.)_________________________
3.)__________________ 3.)_________________________
4,)__________________ 4.)_________________________
___Interior Abatement
___Exterior Abatement
___Soil Abatement
___Other:
___________________________
Date Built (Do not use unknown):___________
Address:_______________________________
City:__________________________________
Zip:___________________________________
S
tart Date:__________
S
top Date:__________
Name: Certification Number:
1.)__________________ 1.)_________________________
2.)__________________ 2.)_________________________
3.)__________________ 3.)_________________________
4,)__________________ 4.)_________________________
___Interior Abatement
___Exterior Abatement
___Soil Abatement
___Other:
___________________________
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Pd-supv-form Project DesignerSupervisorAbatement Worker

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Completed 3 July 2020

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