Cgs Application For Assessment Of Geologic Hazard Reports Page 2
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4APPLICATION FOR ASSESSMENT OF GEOLOGIC HAZARDS REPORTS (p. 2 of 2)
Plans, specifications, and related work were prepared by, and observation of construction will be performed by:
(per Title 24, Part 1, Section 4-316, of the California Code of Regulations)
Architect or Engineer in General Responsible Charge:
Printed Name:
Firm Name:
Address:
Telephone Number:
Fax Number:
California Registration Number:
E-mail Address:
The following individual is authorized to act as Alternate to the Architect or Engineer named above:
Printed Name:
Firm Name:
Address:
Telephone Number:
Fax Number:
California Registration Number:
E-mail Address:
Geologic hazards reports must be prepared by a Certified Engineering Geologist and a Geotechnical Engineer:
(per Title 24, Part 2, Section 1803A, of the California Code of Regulations)
Engineering Geologist Name:
Geotechnical Engineer Name:
Firm Name:
Firm Name:
Address:
Address:
Telephone Number:
Telephone Number:
Fax Number:
Fax Number:
E-mail Address:
E-mail Address:
California Registration Number:
California Registration Number:
For Information regarding review of Geologic Hazard Reports for school projects:
Technical (geology) questions:
Submittal and tracking of reports:
Jennifer Thornburg, PG, CEG, CHG
Margaret Hyland
California Geological Survey
California Geological Survey
801 K Street, MS 12-32, Sacramento, CA 95814-3531
801 K Street, MS 12-32, Sacramento, CA 95814-3531
916.445.5488
916.324.7324
Jennifer.Thornburg@conservation.ca.gov
Margaret.Hyland@conservation.ca.gov
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