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1、WORK PLAN TEMPLATEFOR THE DECONTAMINATION OFILLEGAL DRUG MANUFACTURING SITESA work plan consists of 4 separate documents: General work plan, Pre-decontamination sampling plan, Post-decontamination sampling plan, and Final report. Each document is submitted at the appropriate stage of the decontamina
2、tion project.This is a technical document. The document needs to be complete, legible and attachments are to be numbered and referenced in main document. Local Health Approved: Yes No SIGNATURE DATE_CONTRACTOR INFORMATION:Contractor Company Name:Contractor Mailing Address: Contractor Phone : Copy of
3、 DOH CDL Contractor CertificateSite Supervisor Name Supervisor DOH CDL Certification Number and Expiration DateCopy of DOH CDL Supervisor CertificateWorker NameWorker DOH CDL Certification Number and Expiration DateCopy of DOH CDL Worker CertificateI understand that before any pre-decontamination sa
4、mpling and/or clean up activities can begin, I must submit to and receive written approval of a completed sampling and/or work plan from Local Health Staff.I understand that before any modifications to the approved work plan can be enacted, I must submit to and receive written approval of the modifi
5、cations from Local Health Staff. I understand that upon work plan approval, I will notify the local health staff 24 to 48 hours prior to starting cleanup.I understand that I must comply with all applicable state and federal laws & regulations.I certify that the statements in this work plan are t
6、rue and accurate to the best of my knowledge._ _Contractor Signature DateTable of Contents(List categories and related page numbers)ContentPage_PROPERTY INFORMATION Property Owner Name: Property Owner Mailing Address: Property Owner Telephone Number: Decontaminated Propertys Physical Address: Legal
7、Description of Decontaminated Property (If this is a mobile home or vehicle, include make, model, license plate # & VIN/ID#): Assessors Property Account #/Parcel #: Year Home/Structure was built: Written detailed directions for locating the property from the nearest principal marked road:_ Map:
8、Directional map clearly showing how to get to the property. SITE ASSESSMENTA written evaluation of the real property, vehicles and structures, to assist in determining the nature and extent of potential contamination.Agency Reports: A recording of information from Local Health Department, Law Enforc
9、ement Agencies, Department of Ecology.Site Description: A brief description of property and structures (For example: Property consists of a single family residence, two storage sheds, city septic and water, pond)Site Map: A scaled drawing, that includes locations of all structures, well, septic, sur
10、face water, dump sites, burn piles, vehicles, boats, distressed vegetation etc. On Site Survey: Detailed description of real property, vehicles and structures. Mention; stains, spills, flooring materials, household furniture, childrens items, chemicals, biohazards, odors, basements, attics, crawlspa
11、ces, HVAC systems, wells, septic systems, drain fields, distressed vegetation etc. Floor Plans: Drawn to scale plans of each structure, indicating areas of stains, heating ducts and vents, attics, basements and crawl spaces, Site Photos: High quality, dated photos of property, structures, vehicles,
12、potentially contaminated areas, staining, spills, childrens items, burn piles, dump sites etc. PRE-DECONTAMINATION SAMPLING PLANBefore any pre-decontamination sampling activity can be done, a sampling plan must be submitted to and receive signed approved from Local Health Staff. Description of sampl
13、ing protocols Description of materials, equipment and techniques for sampling of methamphetamine, VOC, and pH Identification of analytical lab (Name, address, phone number and contact person)Sample ID NumberSample Location*AnalyteArea SampledPre Decon ResultsPost Decon ResultsSM1Living room Meth400
14、cm²SM2Bathroom ceiling fanMeth100 cm²SM3Septic (strong solvent odor detected)VOC (to be reported in ppm)1 quartSM4Kitchen Meth400 cm²SM5Sample Blank (for QA/QC)MethPre Decontamination Sampling Table: (Designates where samples will be taken, analyte sampling for, the area to be sampled
15、. The examples shown are for sampling at the “Smith Property” notice that the sample ID number references this by using the first two letters in the last name)*Sample Location: Samples may consist of either single or composite samples. To adequately assess contamination levels, a minimum of one comp
16、osite sample per room is recommended. A composite sample consists of no more than four 100 cm2 sampling locations taken from the same room. Local Health Approved: Yes No SIGNATURE DATE:_DECONTAMINATION PROCEDURESA detailed description of methods used to address contamination. Includes Pre Decontamin
17、ation Sampling Photos, Results Table, and Chain of CustodyPre Decontamination Sampling Photos: Includes high quality, dated photos, showing template over sampled area with sample ID number and a point of reference)Analytical Request Form/Chain-of-Custody Record: Includes chain of custody verificatio
18、n, information necessary for laboratory analysis and LHO interpretation: (Sample #, sample location, area sampled, analyte sampling for, detected odors at VOC sampling locations. See sample form at the end of this template).Pre-Decontamination Sampling Results Table: (Copy of report from analytical
19、lab)Sample ID NumberSample LocationAnalyteArea SampledPre Decon ResultsPost Decon ResultsSM1Living room Meth400 cm500 ug/400 cm²SM2Bathroom ceiling fanMeth100 cm²220 ug/ 100cm²SM3Septic (strong solvent odor detected)VOC1 quart700 ppm TolueneSM4Kitchen Meth400 cm²117 ug/400cm²
20、;SM5Sample Blank (for QA/QC)_Non-detectDECONTAMINATION PROCEDURES (contd)A detailed description of methods used to address contamination.List methods and materials used, including equipment, name of detergent, number of washes and rinses etc. (Describe how decontamination will occur for each structu
21、re, burn pile etc.)Describe how you will address the following issues:· Asbestos· Septic system and drain field· Well· Household furniture · Flooring· Appliances· HVAC/heating systems· Ceilings, walls, floors · Debris· Burn piles and Dump sites·
22、 Demolition· Vehicles· Other (list and address all other pertinent issues)WASTE DISPOSAL PLANA detailed description of methods used to address handling and removal of wastes.Procedures used to designate waste: In your own words, discuss how you determine whether any waste is hazardous wast
23、e. (See Ecology Fact Sheet, “Identify your waste and generator requirements”)Identification of all of the Waste Disposal Facilities you will use on this project: Landfills may request notification that materials to be disposed of are from a drug lab.NameAddressContact Person and Phone NumberDisposal
24、 of Solid Wastes: Identify the waste and the name of the disposal facilityFor Examples:· Household furnishings and items· Appliances· Debris from structures· Septic Waste· Materials from demolitions· Debris from burn piles and yard· Cleaning Rinse Water · Othe
25、rDisposal of Hazardous Wastes: Identify the waste and the name of the disposal facilityFor Examples:ü Anhydrous ammonia cylindersü HCL generatorsü Opened and unopened containers of chemicals (known or unknown)ü Chemicals not associated with drug manufacturing such as bleaches, to
26、ilet bowl cleaners, oven cleaners, motor oil, antifreeze, and oil based paints. ü Refrigerators/air conditioners with refrigerantü Soil above MTCA standardsü Items that Ph < 2 or >12.5ü Fluorescent light tubesü Computer monitorsProcedures used to secure waste when deco
27、ntamination contractor is off site:POST-DECONTAMINATION SAMPLING PLANDescription of sampling protocols Before any post-decontamination sampling activity can be done, a sampling plan must be submitted to and receive signed approved from Local Health Staff.Description of materials, equipment and techn
28、iques: A detailed description of how you take samples for methamphetamine, VOCs, and pH. Be thorough, describing the tools and equipment you use and the process involved. Identification of analytical lab (Name, address, phone number and contact person)Post Decontamination Sampling Table (Lists where
29、 samples will be taken, what you are sampling for, the area to be sampled and pre decontamination sampling results. The examples shown are for sampling at the “Smith Property”. Notice that the sample ID number references this by using the first two letters in the last name and “P” for post clean up
30、samples )Sample ID NumberSample Location*AnalyteArea SampledPre Decon ResultsPost Decon ResultsSM1-PLiving room Meth400 cm²40ug/400 cm²SM2-PBathroom ceiling fanMeth100 cm²220ug/ 100 cm²SM3-PSample BlankNon-detectSM4-PKitchen Meth400cm²117ug/100cm²*Sample Location: Sampl
31、es may consist of either single or composite samples. To adequately assess contamination levels, a minimum of one composite sample per room is recommended. A composite sample consists of no more than four 100 cm2 sampling locations taken from the same room. Local Health Approved: Yes No SIGNATURE DA
32、TE:_. FINAL REPORTSummary and documentation of actual work performed. To be submitted upon completion of decontamination project.Summary of Decontamination Procedures: (Detailed and specific)Summary of Waste Disposal Procedures (Detailed and specific)Receipts Waste Disposal, Subcontractors, Septic Pumper etc. Post Decontamination Sampling Photos: Includes high quality photos, showing template over sampled area, a point of reference, dated and labeled Post Decontamination Analytical Request Form/Chain-of-Custody” Record: Includes chain of custody verification, information nece
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