Laserfiche WebLink
C�rl� • <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 /> SITE SPECIFIC WORK PLAN (SSWP) APPLICATION <br /> SSWP APPLICATION JPB Project#: SSWP Submittal#: <br /> APPLICANT: <br /> ADDRESS: <br /> E-mail Address: <br /> TELEPHONE: FAX:: <br /> LOCATION of PROJECT <br /> PROJECT SITE CONTACT: <br /> DATE(S):REQUESTED: DAILY WORK HOURS REQUESTED: <br /> CLEARANCE TO NEAREST RAIL OF OPERATING TRACK: <br /> DESCRIPTION OF WORK TO BE PERFORMED: <br /> EQUIPMENT TO BE USED IN THE CONSTRUCTION: I <br /> EXCAVATION WITHIN THE RAILROAD ZONE OF INFLUENCE: YES NO <br /> IF SO APPROVED SHORING ATTACHED: YES NO <br /> SAFETY CONSIDERATIONS: <br /> All personnel working on project shall be JPB RWP Safety Trained per FRA Regulations <br /> NOTE: <br /> 1. RETURN COMPLETED FORM TO THE PCJPB,FAX(650)508-7967,BY 4:OOPM 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 ACCURATLEY MAY BE CAUSE FOR THIS PROJECT TO BE <br /> DELAYED OR SHUT DOWN. <br /> APPLICANT NAME(PLEASE PRINT) SIGNATURE <br />� <br />