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ur. r�nviro=emai 1.necmist rage i ci Environmental Checklist In Order for Your Environmental Access Request to Be Reviewed All applications must be accompanied with the following items before your request can be given an initial review by the railroad. Incomplete applications will result in the denial of your application and the loss of your initial $555.00 application payment. ICompleted Application for Environmental Right of Entry Agreement (PDF File Form $555.00 Check ) A non-refundable application fee. (Payable to Union Pacific Railroad Company - Federal Tax I.D. #94-6001323.) Contractor's Information Required for each contractor in all cases where a contractor will work under the agreement. Environmental Site Plan Showing the location of all proposed bore holes, sampling locations, monitor wells, piezometers, / and all other testing locations and/or facilities (must be site-specific and show relation to tracks). Also include regional map showing site location. Work Plan Your work plan must include: . Statement of the work objective. . Statement of who the work is for and what specific person at an agency (with telephone number) is directing the work to be done. If work is not being directed by a gov't agency, provide a statement as to why the work must be conducted on Railroad property. Description of management of Investigation Derived Wastes (IDW). No IDW may remain on UPRR property. IDW must be removed the same day it is generated. Responsible Party is solely responsible for IDW management and proper disposal. NOTE: 1. Test pits or test trenches are stongly discouraged. Approval will require a specific written management plan. All material generated from any test pit or trench activity in connection with an environmental investigation is considered IDW and must be contained and disposed of properly. Test pits or trenches may not remain open and must be back-filled with suitable, certified, clean material before de-mobilizing from the site for the day. 2. It is preferable that all work be conducted at least 25 feet from the nearest track. If this is not possible, you must provide a detailed explanation and the specific / circumstances that will not allow this condition to be met. I/ Agency Directive Statement of who the work is for and what specific person at an agency (with their telephone number) is directing the work to be done. If work is not being directed by a government agency, provide a statement as to why the work must be conducted on Railroad property. Map Regional map showing location of site. Site specific map showing location of investigation points. Map must show relation of investigation points to any existing rairoad tracks. A railroad R/W map or a USGS map with additional detailed site information. For a fee, railroad R/W maps may be obtained from Joe Cuttle, Manager, Engineering Project Management System, Union Pacific Railroad Company, 1400 Douglas St. Mail Stop 0910, Omaha NE 68179, (402) 544-4056. V� Monitor Well Design (If applicable) Showing a typical cross section view of the proposed monitor well/piezometer installation for riser and flush-mounted well. Must show well security. Describe installation methods the types of material that will be used for the casing. Only flush mounted wells are allowed unless State Law prohibits flush mounted wells. (Applicant must provide the specific http://www.uprr.com/reus/environ/checklst.shtml 6/12/2001