APPLICATION FOR HAZARDOUS SUBSTANCE REMOVAL AND REMEDIAL ACTIONS CERTIFICATION

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Easy-Fill Application

IMPORTANT NOTICE REGARDING CONVICTIONS PLEASE READ CAREFULLY

Failure to accurately report a conviction (except as explained below) may result in an application being denied. In this notice and on the application, the term "conviction" includes pleading guilty or nolo contendere ("no contest") or being convicted by a court of any misdemeanor or felony in this state or elsewhere.

As part of the Contractors State License Board (CSLB) application process and as required by law, you must be fingerprinted if you have not been fingerprinted by CSLB before or if your previous fingerprint record was purged by CSLB due to a voided application; disassociated, revoked, or cancelled license or registration; or for some other reason. After an application is accepted by CSLB as complete (also known as "posted"), the applicant will be sent instructions on the process for obtaining and submitting fingerprints, usually via live scan electronic transmission.

Your fingerprints will be compared to the records of the California Department of Justice and the Federal Bureau of Investigation. If you have ever been convicted of a crime, your criminal record information will be reported to CSLB. This includes DUIs and other Vehicle Code violations resulting in a conviction. Even if you pled "no contest," had the conviction set aside, or judgment deferred pursuant to Penal Code sections 1000 or 1203.4 (commonly understood as "expunged"), the past conviction will still be reported to CSLB and must be disclosed on the application. However, some convictions or charges should NOT be disclosed, including the following:

  • Convictions that were adjudicated in the juvenile court;
  • Convictions under California Health and Safety Code sections 11357 (b), (c), (d), or (e) or section 11360 (b) that are two years old or older; and
  • Charges that were dismissed as the result of successful completion of a deferred entry of judgment program (diversion program) under California Penal Code section 1000.3.

If you have ever been convicted of a crime (except in the three circumstances outlined above), you should answer "Yes" to the criminal conviction question on the application and provide a detailed explanation of the circumstances resulting in your conviction. To help ensure that you provide the required information, you should complete and submit the Disclosure Statement Regarding Criminal Plea/Conviction form that is available on CSLB's website on the Forms and Applications page.

Applicants with criminal convictions are not automatically denied licensure - each application is reviewed individually based on the applicable sections of law. When reviewing criminal convictions, CSLB considers factors such as the nature and severity of the crimes, the amount of time that has passed since the convictions, and any evidence of rehabilitation submitted by the applicant.

For rehabilitation evaluation, pursuant to Title 16, California Code of Regulations section 869, CSLB is generally looking for three (3) years to have passed after a misdemeanor conviction and seven (7) years to have passed after a felony conviction, without further violations of law. These timeframes are calculated from the applicant's date of release from incarceration or from the end of probation if no time was served and are subject to reduction or extension based on several factors, including the nature of the applicant's conviction history as a whole. In addition, any type of conviction could be considered substantially related to the qualifications or duties of a contractor when evaluated in the context of the applicant's entire conviction record.

Failure to accurately report any and all disclosable convictions may be grounds for denial of your application. If your application is denied, you will be notified of the earliest date when you may re-apply, which will vary based upon the facts of each case, from one (1) to five (5) years from the effective date of the denial. (Business and Professions Code sections 486 and 7073)

This is an easy-fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

IMPORTANT NOTES:

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IMPORTANT NOTICE

Please be aware that nearly half of all applications submitted to CSLB are inaccurate or incomplete and must be returned to the applicant for correction or completion!

Please complete your application in its entirety to help ensure that your application is accepted for processing by CSLB.

After an application has been accepted by CSLB as complete (also known as "posted"), the applicant will be sent instructions on the process for obtaining and submitting fingerprints, as required by law. (Business and Professions Code sections 144 and 7069)

An incomplete application can needlessly delay your license. Delays can last several weeks or even months and possibly result in the application being deemed abandoned and becoming void and the application fee being forfeited. (Business and Professions Code sections 7074 and 7138 and Title 16, California Code of Regulations section 813)

Spending a few extra minutes now may save you weeks or months later!

Before you submit your application, follow these simple directions.

  • Sign the form.
  • Fill out all applicable information.

Carefully read the General Information and Instructions that immediately precede the application package and follow the specific instructions that are contained throughout the application to help ensure that your application is complete and accurate.

Please be aware that there are no schools or application preparation organizations that are affiliated with or agents of CSLB, although some may have company names that are confusingly similar to CSLB. If you discover that an organization has misrepresented itself as being CSLB, you should submit a complaint to CSLB or the California Department of Consumer Affairs. Official CSLB examination study guides are available free of charge on CSLB's website and are mailed to applicants when they are scheduled for exams.

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General Information and Instructions

Application Fees

Application fee.................................... $83



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Listed below is general information to assist you as you complete the attached application. Detailed instructions are provided on the application. For more information about the Contractors State License Board's (CSLB) hazardous substance removal and remedial actions certification, please refer to Business and Professions Code (BPC) section 7058.7 (see below for an excerpt).

Contractors who perform hazardous substance removal work at specific sites, including the installation or removal of underground storage tanks, must complete this application and pass the examination for hazardous substances certification to add the certification to their existing licenses. Eligibility for this certification is limited to licenses having the following classifications:

  • A - General Engineering
  • B - General Building
  • C-12 - Earthwork and Paving
  • C-36 - Plumbing
  • C-57 - Well Drilling
  • C-61/D-40 - Limited Specialty category for Service Station Equipment and Maintenance

Do not submit this General Information and Instructions section with your completed application - the actual application begins immediately following this section on Application - Page 1 of 2. Before you submit your application, please review and be sure that you have complied with the following items.

  • Enclose the nonrefundable $83 application fee with your completed application to add the hazardous substance removal and remedial actions certification to an existing license. CSLB cannot process your application without the appropriate fee made payable to the Registrar of Contractors. (BPC section 7138 and Title 16, California Code of Regulations [T16 CCR] section 811)
  • Your application may be returned to you if it is insufficient or incomplete. You must provide any missing information, make corrections, and resubmit your completed application to CSLB within 90 days after the date that it was returned to you or your application will be deemed abandoned and become void. You cannot reinstate a void application - you must submit a new application and $83 application fee if you wish to reapply.
  • Your license must be in good standing (i.e., renewed active or inactive, but not expired or suspended) before the certification can be added.
  • Leave no space blank. If a particular question or request for information does not apply to you, write "N/A" in the blank space to indicate that the question has received your attention but that it is not applicable.

Complete the application and all accompanying forms legibly in black or dark blue ink, with a typewriter, or on CSLB's website using the form-fill feature. Forms completed in pencil will be returned to you. Please make sure that you and other authorized individuals sign and date the forms, where applicable.

BPC SECTION 7058.7 EXCERPT

BPC section 7058.7 states, in part, "(a) No contractor may engage in a removal or remedial action, as defined in subdivision (d), unless the qualifier for the license has passed an approved hazardous substance certification examination.

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(d) For purposes of this section 'removal or remedial action' has the same meaning as found in Chapter 6.8 (commencing with Section 25300) of Division 20 of the Health and Safety Code, if the action requires the contractor to dig into the surface of the earth and remove the dug material and the action is at a site listed pursuant to Section 25356 of the Health and Safety Code or any other site listed as a hazardous substance release site by the Department of Toxic Substances Control or a site listed on the National Priorities List compiled pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. Sec. 9601 et seq.). 'Removal or remedial action' does not include asbestos-related work, as defined in Section 6501.8 of the Labor Code, or work related to a hazardous substance spill on a highway.

(e) (1) A contractor may not install or remove an underground storage tank, unless the contractor has passed the hazardous substance certification examination developed pursuant to this section.

(2) A contractor who is not certified may bid on or contract for the installation or removal of an underground tank, if the work is performed by a contractor who is certified pursuant to this section.

(3) For purposes of this subdivision, 'underground storage tank' has the same meaning as defined in subdivision (y) of Section 25281 of the Health and Safety Code."

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Business Name and Addresses (Boxes 1 - 6 on the application)

You must provide the existing business name and addresses as licensed with CSLB, as well as the existing CSLB license number (Box 2). The classifications currently held by the contractor must be listed in Box 3 (see the General Information section regarding allowable classifications). You are also asked to provide business phone and fax numbers and a business email address.

  • Your business address of record (mailing address) is made available to the public - it is published on CSLB's website and is used for service of all official correspondence, notices, and orders from CSLB, such as renewal notices. P.O. boxes and private mail boxes (PMB) are acceptable for the address of record.
  • Your business street address is used only for CSLB's internal administrative purposes - it is not published on CSLB's website. P.O. boxes and PMBs are not acceptable for the business street address.
  • You are also asked to provide business phone and business fax numbers and a business email address. Your business phone number is published on CSLB's website - the other contacts are for CSLB internal purposes and for service of official correspondence.

To change your existing license's business name or address, you must complete and submit the Application to Change Business Name or Address form (13L-4). In accordance with BPC section 7059.1, the business name for a contractor license must not be misleading in relation to the classification(s) issued to that license and must be compatible with the type of business entity licensed.

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The qualifying individual on the license must complete the personnel information requested in Section 2 of the application for the hazardous substance removal and remedial actions certification.

  • Line 7 - Full legal names are required. You must provide the full legal name of the qualifier. If the individual does not have a middle name, write "None" or "No Middle Name" in the space provided. If they have only an initial for their first or middle name, write "(Initial Only)" after the initial.
  • Provide qualifier's date of birth where requested.
  • All applicants are required to provide their U.S. Social Security number (SSN) or individual taxpayer identification number (ITIN) if an individual does not have an SSN. (See note in the Miscellaneous section below regarding collection of SSNs and ITINs.)
  • Boxes 8 and 9 - You must also provide a residence street address for the qualifier that will be used only for CSLB's internal administrative purposes - it will not be published on CSLB's website. P.O. boxes and PMBs are not acceptable for the qualifier's residence street address. Also enter the qualifier's home phone number, fax number, email address, and driver license number.
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Be sure to include the existing licensee's business name at the top of Page 2 where requested. All questions must be answered and all requested explanations and documentation must be provided or the application will be returned to the applicant for correction. Failure to thoroughly and accurately complete this section of the application can delay the licensure process or result in denial of the application.

Conviction Question and Fingerprint Requirement (Question 11 on the application)

Please be sure to read the Important Notice Regarding Convictions on the front of this application packet. All applicants for licensure are required to submit a full set of fingerprints for the purpose of conducting a criminal background check. Fingerprints will be compared to the records of the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI) to determine whether a criminal history exists. Your hazardous substance removal and remedial actions certification cannot be issued until CSLB receives fingerprint results from both DOJ and FBI. Even though you may have been fingerprinted previously for an employer or another regulatory body, you will need to undergo the fingerprinting and criminal history check process again specifically for CSLB, unless you have previously fingerprinted for CSLB and the results are still available and active on record with CSLB. California Penal Code section 11142 prohibits criminal history information from being released to any entity other than the requesting agency that you have authorized to receive it.

After an application has been accepted by CSLB as complete (also known as "posted"), each individual listed on the application who needs to fingerprint will be sent instructions on the process for obtaining and submitting fingerprints. Individuals in California are required to fingerprint by electronic live scan; individuals outside of California can fingerprint either by electronic live scan in California or by submitting hard card fingerprints that are completed in the applicant's location, as explained in the instructions that are sent after the application has been posted. For more information, please visit CSLB's website and view information on the Applicants page.

Military (Questions 14 and 15 on the application)

CSLB approves expedited processing and/or grants credit toward the experience requirements for current and former active duty military and their spouses or domestic partners under specific circumstances, as explained below.

Expedited Processing for Military Personnel and Their Spouses or Domestic Partners

CSLB is required to expedite the licensure process for a sole ownership entity applicant who:

  • An applicant who was honorably discharged after having served as an active duty member of the Armed Forces of the United States; OR
  • An applicant who holds a current license in another state, district, or territory of the United States in the same contractor license classification for which they are applying and who is married to, or in a domestic partnership or other legal union with, a current active duty member of the Armed Forces of the United States who is assigned to a duty station in California under official active duty military orders.

Please see the military questions (numbers 14 and 15) under Section 3 of the application. If you answer "Yes" to either of the questions and you would like to be considered for this expedited processing, please provide the documentation requested under the question, including evidence of your current military duty (copy of your military orders) or your previous military service (copy of your DD 214 - Certificate of Release or Discharge from Active Duty). (BPC sections 114.5, 115.4, and 115.5)

Translator for Examination (Question 16 on the application)

Check the "Yes" box if you have difficulty understanding or reading the English language and you would like to use a translator to read the examination to you. The translator you choose must be approved in advance by CSLB. If you check the "Yes" box, information will be sent to you regarding the translator process.

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You must print and sign your name and indicate the date below the certification statement at the bottom of Page 2 of the application. Failure to sign your application will result in the application being returned to you for correction. Two signatures are required on the application when the qualifier for the certification is a responsible managing employee.

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Examinations

You may be scheduled for the examination within days or weeks from the acceptance of this application. A study guide for the examination is available from CSLB's website at www.cslb.ca.gov or by calling the 24-hour automated phone system at (800) 321-CSLB (2752).

Reasonable Accommodation - The Americans with Disabilities Act

In compliance with the Americans with Disabilities Act (ADA), CSLB provides reasonable accommodation for applicants with disabilities that may affect their ability to take the required examinations. Applicants wishing to request reasonable accommodation pursuant to the ADA must complete the Special Accommodation Request for Examination form (available on the Forms and Applications page on CSLB's website) and submit it to CSLB with the appropriate supporting documentation. In order to make the necessary arrangements to accommodate candidate needs, the form and supporting documentation should be submitted as soon as possible.

Construction Management Education Account

A grant program was established in 1991 to provide funds for qualified public post-secondary schools that teach construction management. Applicants may voluntarily contribute to the account when paying the application fee or the license renewal fee. If you would like to make a voluntary contribution, please mark the box on the top portion of Page 1 of the application, write in the dollar amount in the space provided, and include that dollar amount in the total amount paid with your application, or submit a separate check or money order made payable to CSLB/Construction Management Education Account. (See BPC sections 7139.2 and 7139.4.)

Collection of Social Security Numbers, Individual Taxpayer Identification Numbers, and Federal Employer Identification Numbers

With the exception of the driver license number, all information requested on the application is mandatory, including disclosure of U.S. Social Security numbers (SSN), individual taxpayer identification numbers (ITIN), and federal employer identification numbers (FEIN). Collection of the SSN, ITIN, and FEIN is authorized by BPC sections 30, 31, and 7145.5. SSNs, ITINs, and FEINs are used exclusively for the purpose of tax enforcement, compliance with any judgment or order for family support in accordance with Family Code section 17520, measurement of employment outcomes of students who participate in career technical education programs offered by the California Community Colleges as required by BPC section 30, and investigation of tax evasion and violations of cash-pay reporting laws as set forth in Section 329 of the Unemployment Insurance Code. If you fail to disclose your SSN, ITIN, or FEIN, your application will not be processed and you will be reported to the Franchise Tax Board; they may assess a $100 penalty against you.

Collection of Personal Information

CSLB collects the personal information requested on the following form as authorized by BPC sections 30, 31, 114.5, 115.5, 141, 480, 7058.7, 7066, 7069, and 7145.5 and T16 CCR section 816. CSLB uses this information to identify and evaluate applicants for licensure, issue and renew licenses, and enforce licensing standards set by law and regulation. Submission of the requested information is mandatory. CSLB cannot consider your certification application unless you provide all of the requested information. You may review the records maintained by CSLB that contain your personal information, unless the records are identified as confidential information and exempted from disclosure by the Information Practices Act, including Civil Code section 1798.40. CSLB makes every effort to protect the personal information you provide us; however, it may be disclosed in response to a Public Records Act request as allowed by the Information Practices Act; to another government agency as required by state or federal law or as provided in Civil Code section 1798.24; or in response to a court or administrative order, a subpoena, or a search warrant. The Custodian of Records is responsible for maintaining the information on this form and may be contacted at the address and telephone number listed in the letterhead at the top of this General Information and Instructions portion for questions about this notice or access to records.

Application Processing - Follow Your Application Status Online

When CSLB receives your application, an acknowledgement letter will be sent to you that explains how to check the status of your application online at www.cslb.ca.gov or by calling (800) 321-CSLB (2752) using the Application Fee Number and Personal Identification Number (PIN) provided in the acknowledgement letter.

Please include your Application Fee Number in any correspondence. All correspondence should be sent to:

Contractors State License Board
9821 Business Park Drive
Sacramento, CA 95827-1703
Mailing Address: P.O. Box 26000, Sacramento, CA 95826-0026

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SECTION 1 - BUSINESS NAME AND ADDRESS

Voluntary Contribution

Business Name

The full business name must be provided. Please refer to Section 1 of the General Information and Instructions for information on business name styles.
*BUSINESS MAILING ADDRESS
*BUSINESS STREET ADDRESS

* Required Entry

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SECTION 2 - CERTIFICATION APPLICANT (QUALIFIER) FULL LEGAL NAME AND ADDRESS

Qualifying Individual (Qualifier)

A qualifying individual is required for every classification on every license issued by CSLB. You must provide full legal names of all individuals. (See Section 2 of the General Information and Instructions for more information on completing this section.)
 
*RESIDENCE ADDRESS

* Required Entry

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SECTION 3 - REQUIRED QUESTIONS

All questions in this section must be answered by the certification applicant only. If you checked "Yes" in response to any question, you must attach a separate sheet with a detailed explanation for each situation.

*Question 10

To the best of your knowledge, are you (or any company that you are or were a part of) named in or responsible for any unsatisfied final judgments, liens, and/or claims against any bond or cash deposit pertaining to a construction project?

If you checked "Yes" for this question, you are required to attach a statement identifying all judgments (pending or on record), liens, past due unpaid bills, claims, or suits and a detailed explanation of the situation. Include the names and addresses of the parties involved. If the obligation was or is being discharged in bankruptcy, attach a copy of the bankruptcy filing and a copy of the creditors list.

*Question 11

Have you EVER been convicted of or entered a plea of guilty or nolo contendere to ANY misdemeanor or felony in the United States or a foreign country? NOTE: Convictions that were later expunged from the records of the court or set aside pursuant to California Penal Code sections 1203.4, 1203.4a, or 1203.41 or an equivalent non-California law MUST be disclosed. However, some convictions should NOT be disclosed, including the following:
  • Convictions that were adjudicated in the juvenile court;
  • Convictions under California Health and Safety Code sections 11357 (b), (c), (d), or (e) or section 11360 (b) that are two years old or older; and
  • Charges that were dismissed as the result of successful completion of a deferred entry of judgment program (diversion program) under California Penal Code section 1000.3.

If you checked "Yes" for this question, please attach a statement disclosing all pleas/convictions, including violated law sections, and thoroughly explain the acts or circumstances that resulted in the plea/conviction. In addition, the following information must be included for each plea/conviction: date of the plea/conviction, level of the plea/conviction (i.e., misdemeanor or felony), county and state where the violation took place, name of the court, court case number, sentence imposed, jail/prison term served, terms and conditions of parole or probation, parole or probation completion dates, and parole agent/probation officer names and phone numbers. If you have obtained a dismissal of your conviction(s) pursuant to Penal Code sections 1203.4, 1203.4a, or 1203.41, please submit a certified copy of the court order dismissing the conviction(s) with your application. You may submit the required information using the Disclosure Statement Regarding Criminal Plea/Conviction form that is available on the Forms and Applications page on CSLB's website.

The information provided will be verified through CSLB's fingerprinting requirement. Failure to report a disclosable plea/conviction may be grounds for denial of your application.

*Question 12

Have you (or any company that you are or were a part of) ever received a citation from CSLB or had a contractor license or other professional or vocational license or registration denied, suspended, revoked, or otherwise disciplined by this state or elsewhere (i.e., other U.S. state, U.S. territory, agency of the federal government, or other country)?

For the purposes of responding to this question, "disciplined" is an administrative action that resulted in a restriction or penalty being placed on any license you have or have possessed, such as a revocation, suspension, probation, or reprimand.

(Check "No" if the license or registration was suspended due to lack of a bond, workers' compensation or other required insurance, a qualifier, or family support.)

If you checked "Yes" for this question, you are required to attach a statement detailing the events leading to the CSLB citation or the license or registration being denied, suspended, revoked, or otherwise disciplined.

*Question 13

To the best of your knowledge, have you failed to resolve any outstanding final liabilities, which include taxes, additions to tax, penalties, interest, and any fees that may be assessed by CSLB, the Department of Industrial Relations, the Employment Development Department, the Franchise Tax Board, or the State Board of Equalization (BOE)?

If you checked "Yes" for this question, you are required to attach a statement regarding the outstanding liabilities. In relation to BOE liabilities, you must indicate if you have entered into an installment payment agreement for that liability with the BOE and provide verification that you are in compliance with the terms of that agreement, if applicable.

*Question 14

Are you serving in, or have you previously served in, the United States military?

If you checked "Yes" for this question, please provide the following documentation:

  • Evidence of your current military duty (copy of your military orders) or your previous military service (copy of your DD 214 - Certificate of Release or Discharge from Active Duty).

*Question 15

(This question must be answered only if the applicant is an individual who holds a sole ownership business entity license.) Are you married to, or in a domestic partnership or other legal union with, an active duty member of the Armed Forces of the United States who is assigned to a duty station in California under official active duty military orders AND do you hold a current license in another state, district, or territory of the United States as a contractor in the same classification for which you are seeking licensure? If you checked "Yes" for this question, please provide the following documentation to be considered for expedited processing:
  • Evidence of your legal union and your spouse's or partner's military duty. For example, attach a copy of the marriage certificate or certified declaration/registration of domestic partnership filed with the Secretary of State AND military orders establishing a duty station in California. For other forms of "legal union" not recognized by California, you may submit other documentary evidence of legal union issued by the state that recognizes your legal union for consideration by CSLB in meeting this requirement; AND
  • Copy of your current license from the other state, district, or territory of the United States documenting a contractor license, registration, permit, or certificate in the same classification for which you are seeking licensure.

N/A=qualifier is not an individual applying for a sole ownership license

*Question 16

The examinations are administered in English. Will you require the use of a CSLB-approved translator?

STATE TAX AND OTHER OBLIGATIONS NOTICE

The State Board of Equalization and Franchise Tax Board may share taxpayer information with CSLB. You are obligated to pay your state tax obligation. CSLB may suspend or refuse to issue, reactivate, reinstate, or renew a license if your state tax obligation, child support obligation, or any outstanding final liability to CSLB, the Department of Industrial Relations, or the Employment Development Department is not paid. (BPC sections 30, 31, and 7145.5)

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Review and Edit

Please Review the Following Information

This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

MAILING ADDRESS

STREET ADDRESS

RESIDENCE ADDRESS


Agree To Complete

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Completion Instructions

NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.



Mail your document(s) along with the application to:


Contractors State License Board
P. O. Box 26000
Sacramento, CA 95826

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