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EHD Program Facility Records by Street Name
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WALNUT GROVE
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9015
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3500 - Local Oversight Program
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PR0545731
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Last modified
6/4/2020 12:16:20 PM
Creation date
6/4/2020 11:56:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
RECORD_ID
PR0545731
PE
3528
FACILITY_ID
FA0004572
FACILITY_NAME
LOPEZ, ADOR
STREET_NUMBER
9015
Direction
W
STREET_NAME
WALNUT GROVE
STREET_TYPE
RD
City
THORNTON
Zip
95686
APN
00114040
CURRENT_STATUS
02
SITE_LOCATION
9015 W WALNUT GROVE RD 11
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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,i <br /> I� <br /> TRAINEE/OBSERVER AGREEMENT FORM <br /> Groundwater Technology is committed to providing a safe working environment for all employees. in <br /> addition, Groundwater Technology will comply with OSHA requirements for employee safety training <br /> prior to working on any hazardous site. <br /> The fallowing section is to be filled out by trainee. <br /> Agreement between: <br /> Name (print/type) SS# and Groundwater Technology. <br /> -• <br /> Because we have your safety in mind, you will be considered a trainee until all training criteria are met. <br /> This means you must complete all training requirements prior to performing work activities on.site. As a <br /> requirement of the training program, you will be asked to visit Groundwater Technology sites as an <br /> observer. You must be supervised on all of these site visits. <br /> As an on-site observer trainee, your signature below Indicates your agreement to these restrictions. <br /> You may not: <br /> 1. Perform work functions of any type. <br /> 2. Handle any equipment/tools and/or supplies of any type. <br /> 3. Enter any hazardous or hot zone areas. <br /> I agree to adhere to the above conditions in all instances while on site as a trainee/observer. <br /> Signature Date <br /> This section is to be filled out by supervisor. <br /> As supervisor to the above trainee, I agree to the above restrictions and agree not to request him/her to <br /> perform activities contrary to those restrictions. <br /> Signature Date <br /> —mow GROUNDWATER <br /> TECHNOLOC1' <br />
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