ࡱ> #` bbjbjmm 7n4BBBB 1 1 18D1<1@f2~44444^K67d @"@"@"@"@"@"@$CBhDpF@Q94499F@BB44@m;m;m;9pB844 @m;9 @m;m;;z;42 p#w 1):d;4<@0@;E:E;E;Ds7v7Tm;=8D88s7s7s7F@F@;^s7s7s7@9999h(h(4"BBBBBB  JOHN ELIAS BALDACCI GOVERNOR David P. Littell COMMISSIONER STATE OF MAINE DEPARTMENT OF ENVIRONMENTAL PROTECTION NEW APPLICATION FOR ASBESTOS TRAINING COURSE APPROVAL Complete all sections of the application either by hand printing in ink or typing in the gray areas. Print out and sign the completed application and mail to Maine DEP with the appropriate application fee. Attach additional sheets as necessary. 1. Applicant:Company Name FORMTEXT  Company Address FORMTEXT  City FORMTEXT  State FORMTEXT  Zip FORMTEXT      Company Phone Number FORMTEXT  e-mail address FORMTEXT  Previous License Number (if applicable): FORMTEXT  Training Director (must be a Design Consultant) FORMTEXT  Title FORMTEXT      2. APPLICATION INFORMATION:A)Course (s) for which approval is requested: FORMCHECKBOX ABATEMENT WORKER (32 hrs) FORMCHECKBOX ANNUAL REFRESHER (8 hrs.) FORMCHECKBOX ABATEMENT SUPERVISOR (40 hrs) FORMCHECKBOX ANNUAL REFRESHER (8 hrs) FORMCHECKBOX MANAGEMENT PLANNER (16 hrs) FORMCHECKBOX ANNUAL REFRESHER (4 hrs) FORMCHECKBOX AIR MONITOR (16 hrs) FORMCHECKBOX ANNUAL REFRESHER (4 hrs) FORMCHECKBOX AIR MONITOR (40 hrs) FORMCHECKBOX INSPECTOR (24 hrs) FORMCHECKBOX ANNUAL REFRESHER (4 hrs) FORMCHECKBOX DESIGN CONSULTANT (24 hrs) FORMCHECKBOX ANNUAL REFRESHER (8 hrs) FORMCHECKBOX AIR ANALYST (36 hrs) FORMCHECKBOX BULK ANALYST (36 hrs.) B) If the applicant is currently licensed, certified, or permitted to provide training in another state, or does business under any name other than listed above, provide the Department with the name of the State and applicable license, certificate, permit number and a list of approved training courses. C) Provide the Department with the name and qualifications of the Training Director responsible for administering the training course (must be a Maine certified Design Consultant), including a copy of the certificate of successful course completion of a "Train the Trainer" course, or documentation of post-secondary degree in adult education. D) Provide the Department with the name(s) and qualifications of the training instructors. This information must be updated periodically when significant changes in instructors occur. E) Provide the Department with the course agenda including the amount of time allotted for each topic. F) Provide the Department with a copy of any printed material (texts, pamphlets, etc.) that will be provided to students, including a description of the equipment that will be utilized in classroom lectures. Provide the Department with a description of the teaching methods to be utilized, including but not limited to a disc of audio/visual aids. H) Provide the Department with a sample copy of the uniquely numbered certificate to be issued to students who complete the course. I) Provide the Department with a description of the facility to be used, including a description of the equipment that will be utilized for hands-on practice exercise. 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SIGNATURE: I CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. SIGNED:  DATE: FORMTEXT   PRINTED:  RETURN TO: Lead & Asbestos Hazard Prevention Program Department of Environmental Protection (BRWM) 17 State House Station Augusta, Maine 04333-0017 (207) 287-2651     Asbestos Training Course 10/19/2007 }``````aaaaa,a $Ifgd*! h8(0^`0gd| ..^.`gd| h8(`^``gd| aa*a+a;aaaaaaaaaaaa b bbbbbbbbɼh*!h|hU CJOJQJh|CJOJQJhBjhBUhh|CJOJQJhh|5OJQJhh|OJQJhh|OJQJmHnHujhh|OJQJU,a-a.a7a8a9a[RRRR $Ifgd*!kd|J$$Ifl\w,"9 t0644 layt*!9a:a;a[{F,CSum9γ anҔgt 4(i11a|hB%MИ`ӌfOјv#h^lM>  4r_, =iKN!03s4;u ՌChhmM5#:N3[&& Ml8HO4jl# ui,J44Od,$iJF66ndh4,ΐQ ǕbRی s1M4Ni0'xQӻ!8iiTJ^٢)MFЙFUѷ rJ#,V,$DoK8!g6*'iz9繩K@iǓ@J41; k?0MRkF{,|^? d;hb G."J^i ䷧yvu(#4*Ѥ&T#b}XtXVhړ1kr#|iڲOGV]V)s+7Ѥ NytMՓ0=?k=JQ]iG=Y!$v13A=6>RRUM'_4T \?*5nԴibeh_9O~otzj-!V-jicwnOs+Ќ0޴e;9qݨnzFlps9 %6ϾWbsyhw#h|PʱM4;Uc-Հ|l|Ϡ&yfO9O֝;Jє3 _Fe#wEbaS H-cѨhybu3DZI߸]y(g#v:zc ׏~4e'gˤϲHѯhco&f4fAEewbaѭjߌ&Ai4zSGccf^Stp},3ςfܒh|Xh~nGq ߏf|")`}̈$NH7asv=:h0mxnb۽|8x&Y6 i瓖6m=]''4M}ezl)ͦ<h+j#i jD<44d4=0ȧ+B}O66h& ߐnt_g=Ǜ@3,hiO(n4cG<:64wSl&4Ïy~1KwL ?NtML{u%Ɇ"4>]D8U7?͔G$lԝHGJdZ&LA[uY6%s1/u5 MEl@ӕ `sY! 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