Woodside, CA · San Mateo County
PCBs Screening Assessment Form
Property owners or their consultants complete this form to screen a building for PCBs and report assessment results when applying for demolition.
What this form is
The Town of Woodside requires applicants to complete applicable parts of this form and submit it with a demolition permit application. It asks for owner, consultant, and project details, then screens the building based on its construction, use, and age. If Part 3 applies, applicants report PCB concentrations and provide supporting sampling information; all applicants complete the certification.
Who needs it
Property owners or their consultants submitting a demolition permit application must complete applicable parts of the form and provide required supporting information.
How to submit it
Submit the completed form with your demolition permit application to the Town of Woodside. The form lists the Town at 2955 Woodside Rd, Woodside, CA 94062.
About notarization
This document is signed and dated without a notary; it asks the property owner or representative and the consultant completing the form to certify the information.
How to submit this form
- 1
Download The Form
Download the PCBs Screening Assessment Form for your demolition permit application.
- 2
Complete Applicable Parts
Fill in owner, consultant, and project details, answer the screening questions, and complete the certification.
- 3
Gather Supporting Information
If Part 3 applies, report PCB concentrations and include the supporting reports and other information specified for your sampling option.
- 4
Submit With Your Permit Application
Submit the completed form and required supporting information with your demolition permit application to the Town of Woodside.
Frequently asked questions
- Do I need a notary for the PCBs Screening Assessment Form?
- No. The form has signature and date lines for the property owner or representative and the consultant, but no notary block.
- How do I submit the PCBs Screening Assessment Form?
- Submit the completed form with your demolition permit application to the Town of Woodside. The form lists the Town at 2955 Woodside Rd, Woodside, CA 94062.
- Who completes the PCBs Screening Assessment Form?
- The property owner or their agent and the consultant provide information and sign the certification. All applicants complete Parts 1, 2, and 4; Part 3 applies in specified cases.
- What supporting information may be required?
- When Part 3 applies, provide a contractor’s report and analytical data reports. For representative sampling, the form also calls for a QA/QC checklist.
Need something notarized?
This PCBs Screening Assessment Form doesn’t need a notary — but if you have another Woodside form that does, a commissioned online notary can help.