New Jersey Department of Health

Consumer, Environmental and Occupational Health Service

P. O. Box 360

Trenton, NJ 08625-0360

STATEMENT OF EDUCATION AND EXPERIENCE REQUIREMENTS

SUPERVISOR FOR COMMERCIAL BUILDINGS AND SUPERSTRUCTURES

Education and Experience Requirements

Prior to training, all individuals applying for a lead Supervisor for Commercial Buildings and Superstructures permit must certify that they meet the minimum education and experience requirements as set forth at N.J.A.C. 8:62-3.2(f). A permit will be issued only to those applicants who meet the following:

1.	A minimum of two years of experience in industrial painting;

2.	A minimum of 90 days of experience in field supervision or management in hazardous paint removal within the previous 24 months; and

3.	Work experience demonstrating knowledge of relevant safety practices, waste handling procedures and environmental monitoring.
Certification

I do hereby certify that I have read the above education and experience qualifications for a lead Supervisor for Commercial Buildings and Superstructures permit. I understand that I will be required to submit proof of my education and experience when I submit my "Application for Lead Permit" to the New Jersey Department of Health (NJDOH). I also understand that this information will be subject to verification by the NJDOH. If such information submitted is found to be false, I may be subject to the penalty provisions of N.J.A.C. 8:62, which may include the revocation of any permit(s) issued by the NJDOH and/or a civil administrative penalty of $1000 to $5000 per violation.

Please check one of the following:

I meet the above requirements I do not meet the above requirements
Name of Trainee (Print)

Signature	Date

Name of Training Manager (Print)

Agency Number

Signature	Date

CEHS-19

JAN 14

CEHS-19

ewhite

2013-11-25

NJDOH