Work Authorization

WORK AUTHORIZATION
VEHICLE REMOVAL - SITE REMEDIATION - LAND RESTORATION

Date*

TIME:*

: HH

MM

FACILITY/BUSINESS:*

ADDRESS:*

Street Address City State ZIP Code

OWNER/AGENT:*

VEHICLE INFO:

MAKE:*

LIC:*

VIN:*

MAKE:*

LIC:*

VIN:*

CARGO:*

ENVIRONMENTAL IMPACT:

HAZMAT RESPONSE:*

SITE REMEDIATION:*

LAND RESTORATION:*

Due abandonment and/or environmental safety/impact present, in accordance with CVC 22658, CVC23113 and CVC 17300 I, the undersigned, authorize Ten-West Towing, Inc. to remove the vehicle/vehicles. I also give full authority for Ten-West Towing, Inc. to remediate the environmental impact and restore the land/property to its natural state as if before the environmental incident occurred.

Signature

TITLE:*

PHONE:*

EMAIL:*

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