Section Env-A 1812.04 - Application for Certification Individuals seeking certification to disturb asbestos at an asbestos disposal site (ADS) for the first time, individuals seeking re-certification to disturb asbestos at an ADS more than one year after their most recent certification has expired, and individuals seeking re-certification to disturb asbestos at an ADS after their most recent certification has been revoked shall comply with the following:
(a) The individual seeking certification shall apply in writing to the department on an "Application for Asbestos Disposal Worker/Worker-in-Training Certification" form obtained from the department;(b) The application shall include the following:(1) The applicant's name, mailing address, daytime telephone number, fax number, email address, business name or place of employment if any, and date of birth;(2) The name, address, and daytime telephone number of each entity or individual licensed, or to be licensed pursuant to Env-A 1811, with whom the applicant is currently employed or otherwise associated for the performance of work involving the disturbance of asbestos at asbestos disposal sites;(3) A list of all state or federal enforcement actions, both past and pending, against the applicant with regard to environmental, health or safety activities, and the current status of each such enforcement action;(4) Identification of all certifications and licenses, both past and present, issued to the applicant pursuant to He-P 5000 or Env-A 1800, and the current status of each;(5) Whether the applicant is seeking certification as an experienced worker or a worker-in-training, based on the criteria provided in Env-A 1812.08(b);(6) One 2-inch by 2-inch, current, clear, non-mutilated, and unstapled color photograph of the applicant's face, with the name of the applicant legibly printed on the back side; and(7) Written documentation showing that the applicant meets the certification requirements specified in Env-A 1812.08, including:a.A record, signed by the work supervisor(s) or training provider(s), showing that the applicant attended and completed basic training in accordance with Env-A 1813;b.A statement by the applicant attesting that he or she has read and comprehends all information as required by Env-A 1812.08(a)(2);c.A test score report issued by the department showing the date and results of an examination taken by the applicant in accordance with Env-A 1813.03(c); andd.A work experience record, signed by the work supervisor(s), documenting the number of hours the applicant has engaged successfully in the disturbance of asbestos at asbestos disposal sites pursuant to the requirements in Env-A 1812.08(b).(c) The application shall be dated and signed as specified in Env-A 1810.06.(d) An application fee of $50 shall accompany each application. Payment shall be in the form of cash, company check, certified check, or money order. A company check, certified check or money order shall be made payable to "Treasurer, State of New Hampshire".N.H. Code Admin. R. Env-A 1812.04
(See Revision Note at chapter heading for Env-A 1800) #9298, eff 10-21-08
Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12172, Effective 5/5/2017, Expires 5/5/2027.