State of California – California Environmental Protection Agency Department of Toxic Substances Control

CLAN LAB REMOVAL WORK LOG

CLUE #:

CONTRACTOR’S PHONE:

DATE(S) OF REMOVAL:

LOCATION OF REMOVAL:

CONTRACTOR:

CONTRACTOR’S REPRESENTATIVE:

DESCRIPTION OF CLANDESTINE LABORATORY (TYPE OF PROCESS):

DESCRIPTION OF

REMOVAL

ACTIVITIES:

EQUIPMENT USED

ITEM DESCRIPTION TIME OF ARRIVAL

TIME OF DEPARTURE

12345

LABOR USED

STAFF JOB CLASSIFICATION TIME OF ARRIVAL

TIME OF DEPARTURE

1 2345

MATERIALS USED

ITEM DESCRIPTION NUMBER OF UNITS 12345

(USE ADDITIONAL SHEETS FOR THE ABOVE INFORMATION IF NEEDED)

COMMENTS ON CONTRACTOR'S PERFORMANCE:

HAULER NUMBER:

MANIFEST NUMBER:

TITLE:

REGISTERED HAULER USED:

MATERIAL TRANSPORTED TO:

TIME AND DATE JOB WAS COMPLETED:

REPORT PREPARED BY:

NAME:

AGENCY:

DTSC 1206 (6/2019)