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TYPE OF ENVIRONMENTAL TESTING NUMBER OF EACH <br /> Subsurface Soil/Sediment Samples <br /> Hand Held Auger Borings 4 <br /> Soil Gas Survey Points <br /> Boring Drilled w/Soil Samples <br /> Temporary Piezometer Wells <br /> Temporary Monitor Wells(must be flush-mounted) <br /> Permanent Monitoring Wells <br /> Recovery Wells&Associated above Ground Equipment <br /> Recovery Systems&Above Ground Equipment <br /> Other(Describe fully) <br /> SPECIAL PROVISIONS: <br /> CONFIDENTIALITY(Required for all cases involving sale of Railroad property&in many other cases.) <br /> X RAILROAD FLAGMAN(Required in all Phase II/III cases&many other cases.) <br /> MONITORING WELL(Required for all monitor wells&piezometers.) <br /> X FURNISH INFORMATION(Required in all cases.) <br /> PROOF OF FINANCIAL CAPABILITY OR PERFORMANCE BOND(Required for all monitor wells, <br /> piezometers,&other facilities.) <br /> CONTRACTOR INFORMATION: <br /> (Must be copied for all contractors that will work under this agreement) <br /> NAME OF CONTRACTOR <br /> INCORPORATED IN WHAT STATE <br /> FULL MAILING ADDRESS <br /> NAME&TITLE OF CONTRACTOR CONTACT PERSON <br /> CONTRACTOR TELEPHONE NUMBER <br /> CONTRACTOR FAX NUMBER <br /> EMAIL ADDRESS <br /> (X) COMPLETE AND RETURN THIS APPLICATION FORM,with <br /> (X) A$555.00 CHECK(Payable to Union Pacific Railroad Company),and <br /> (X) THE OTHER REQUESTED MATERIAL ON THE CHECKLIST <br /> to the appropriate Environmental Access Manager. <br /> NOTE: Other fees and charges may be applicable to your request. These charges cannot be determined until your <br /> Project is approved. <br />