Campbell, CA · Santa Clara County
PCBs Screening Assessment Form – Part 2
Property owners or their representatives use this form to report PCBs assessment results for a demolition site when Part 1 directs them to complete Part 2.
What this form is
Complete Part 2 when the PCBs Screening Assessment Form – Part 1 directs you to do so, and submit it with the demolition permit application. The form asks for proposed demolition site, owner, and consultant information; PCBs sampling or existing-record results; supporting reports and analytical data; and signed certifications. Attach the completed Part 1 form.
Who needs it
Property owners or representatives completing a demolition permit application need this form when Part 1 directs them to complete and submit Part 2.
How to submit it
Submit the completed form and Part 1 to the City/Town Building Department with the demolition permit application. The form lists Campbell Building Department at (408) 866-2130 for questions.
About notarization
This document is signed without a notary; the property owner or representative and the consultant or contractor completing the form sign and date their certifications.
How to submit this form
- 1
Download The Form
Download the PCBs Screening Assessment Form – Part 2.
- 2
Complete The Form
Complete Part 2 when Part 1 directs you to do so, and select an assessment option.
- 3
Gather Attachments
Attach completed Part 1 and the supporting reports and data required for your selected option.
- 4
Sign And Submit
Sign and date the certifications, then submit the form with the demolition permit application to the City/Town Building Department.
Frequently asked questions
- Who completes the PCBs Screening Assessment Form – Part 2?
- The property owner or representative and the consultant or contractor completing the form provide information and sign the required certifications.
- How do I submit the PCBs Screening Assessment Form – Part 2?
- Submit the completed form with Part 1 to the City/Town Building Department alongside the demolition permit application.
- What supporting documents are required?
- The form requires consultant documentation and analytical data reports. Depending on the selected option, it also requires a QA/QC checklist.
- Do I need a notary for the PCBs Screening Assessment Form – Part 2?
- No. This document is signed without a notary; the property owner or representative and the consultant or contractor sign and date their certifications.