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<br />Cal, <br /> <br /> <br />Peninsula Corridor Joint Powers Board (PCJPB), P. O. Box 3006 (1250 San Carlos Ave.), San Carlos, CA 94070-1306, <br />Engineering Department, (650) 508-7968, FAX (650) 508-7967 <br /> <br />SITE SPECIFIC WORK PLAN (SSWP) APPLICATION <br /> <br />SSWP APPLICATION <br />APPLICANT: <br />ADDRESS: <br /> <br />JPB Project #: <br /> <br />SSWP Submittal #: <br /> <br />E-mail Address: <br /> <br />TELEPHONE: <br />LOCATION of PROJECT <br />PROJECT SITE CONTACT: <br />DA TE(S):REQUESTED: <br /> <br />FAX:: <br /> <br />DAILY WORK HOURS REQUESTED: <br /> <br />CLEARANCE TO NEAREST RAIL OF OPERATING TRACK: <br />DESCRIPTION OF WORK TO BE PERFORMED:, <br /> <br />EQUIPMENT TO BE USED IN THE CONSTRUCTION: <br /> <br />EXCAVATION WITHIN THE RAILROAD ZONE OF INFLUENCE: <br />IF SO APPROVED SHORING ATTACHED: <br /> <br />~ <br />,YESD <br /> <br />~ <br />NO--D <br /> <br />SAFETY CONSIDERATIONS: <br /> <br />All personnel working on project shall be JPB RWP Safety Trained per FRA Regulations <br /> <br />NOTE: <br />1. RETURN COMPLETED FORM TO THE PCJPB, FAX (650) 508-7967, BY 4:00PM ON TUESDAY THREE <br />WEEKS PRECEEDING WORK (EVERY WEEK, WEEKS BEGIN ON MONDAY) IN ORDER TO <br />SCHEDULE INSPECTION AND/OR FLAGMEN. <br />2. WORK REQUIRING SHORING MUST INCLUDE ALL SHORING DRAWINGS STAMPED AND <br />APPROVED BY A REGISTERED CIVIL ENGINEER AND BEAR THE APPROVAL OF THE JPB. <br />3. ' FAILURE TO COMPLETE THIS FORM ACCURA TLEY MAYBE CAUSE FOR THIS PROJECT TO BE <br />DELAYED OR SHUT DOWN. <br /> <br />APPLICANT NAME (PLEASE PRINT) <br /> <br />SIGNATURE <br />