Brisbane, CA · San Mateo County
PCBs Screening Assessment Form
This form screens a building for PCBs before demolition and is completed by the property owner or agent, with consultant information and supporting records as applicable.
What this form is
Submit the completed form with a demolition permit application. All applicants complete Parts 1, 2, and 4; answers in Part 2 determine whether Part 3 is also required. The form asks for owner, consultant, and project details, screening answers, and—when applicable—PCB concentration results and supporting documentation.
Who needs it
Applicants seeking demolition permits complete this form for each building to be demolished and provide Part 3 information when the screening answers require it.
How to submit it
Submit the completed form with your demolition permit application, as directed on the form. It does not specify a submission address, email, portal, or fee.
About notarization
This document is signed and dated without a notary; the property owner or agent and the consultant completing the form sign and date it.
How to submit this form
- 1
Download the Form
Download the PCBs Screening Assessment Form for the building proposed for demolition.
- 2
Complete Parts 1 and 2
Provide owner, consultant, and project information, then answer the screening questions in Part 2.
- 3
Complete Applicable Sections
Complete Part 3 if the Part 2 answers require it, include the required supporting information, and complete Part 4.
- 4
Submit With Your Permit Application
Submit the completed form with your demolition permit application.
Frequently asked questions
- Do I need a notary for the PCBs Screening Assessment Form?
- No. The form has signature and date fields for the property owner or agent and the consultant; neither signature requires notarization.
- Who completes the PCBs Screening Assessment Form?
- Applicants seeking demolition permits complete the form. It includes information for the property owner or agent and the consultant completing the application.
- When do I need to complete Part 3?
- Part 2 determines whether Part 3 is required. Complete Part 3 when the building meets the form’s applicable-structure criteria and the proposed demolition is of the entire building.
- How do I submit the PCBs Screening Assessment Form?
- Submit the completed form with your demolition permit application. The form does not give a submission address, email, or portal.