Attachment C - Stormwater_Maintenance_Contractor_Questionnaire.pdf

Submit forms by email to:

Alecia Donaldson alecia.donaldson@dc.gov

(202) 480 - 3867

Government of the District of Columbia Department of Energy & Environment

Inspection & Enforcement Division

Stormwater Management (SWM) Maintenance Service Contractor Questionnaire (All items must be completed; submit forms to contact listed below)

Name and Address of Company:

Telephone #: __________________________Fax #:___________________________________

E-mail: ______________________________ Web address: ____________________________

Required response

Please select the SWM Best Management Practice (BMP) maintenance contractor list you are requesting to be added to:

____ Green Infrastructure BMP

(ex: LID, bioretention, permeable pavers, rainwater harvesting, other)

____ Gray Infrastructure BMP (ex: Sand filter, concrete vault/chamber, other)

____ Green Roof BMP G re e n In fr as tr u ct u

G ra y

In fr as tr u ct u

G e n

R o o f

1. List business license/certifications related to your business operation in DC (Attach Copy).

2. Types of BMP maintenance services provided (Attach List).

3. Inventory of all equipment used for BMP maintenance (Attach List).

4. Do all field staff of your company have the following trainings? (Attach copy).

(a) Confined Space Training Y___N___

(b) Fall Protection Training Y___N___

5. Does your company have the ability to characterize materials to be transported and disposed of? Y__ N__ (Attach copy of methods, operating procedures or laboratory used).

6. List disposal sites used for residuals and liquid waste recovered.

7. Resident state oil control permit number State_____ Permit #________________

8. Name and address of resident agent in District of Columbia for company (If applicable).

9. List of completed projects for the category you are applying for; (1) year of related experience minimum. Show scope of work performed on each project.

Printed Name: __________________ Signature: _________________ Date: ______________

DO NOT WRITE (DDOE ONLY)

Approval Signature: _________________

Approval Date: _____________________

Approved for:

___ Green Infrastructure BMP

___ Gray Infrastructure BMP

___ Green Roof BMP