Appendix_A,_Contractor_Asbestos_Notification_Record.doc

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Fire Suppression IT&M
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W911PT-18-Q-0046
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Appendix A

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Contractor asebstos notification RECORD Watervliet arsenal Public Works REVISED 14 March 2013

Project Number:

(Contract or Requirements Document)

Company Name:

Company Officer (Print):

Title:

Type of Business: _______________________________________________________

I have reviewed the Asbestos Inventory for the location of Asbestos Containing Materials (ACM), related to my contracted work location(s) at Watervliet Arsenal. I have also provided the information to my employees, as it pertains to the location(s) of the ACM on this project. If suspected ACM is discovered during the course of our work, we will stop and notify the Contracting Officer.

Signature:

Date:

Note: In accordance with the Asbestos Operation & Maintenance Plan, all contractors must review the Asbestos Inventory related to his/her contract. This document is a record that the contractor has received the inventory and is aware of any known ACM that may be encountered during his/her execution of the contract.

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