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Project: <br />Project Number: <br />Form Completion Date:Form Expiration Date: <br />Pre-Field Work <br />Required: One Call or "811" notified 48-72 hours in advance of work?#: <br />Ticket Expiration Date <br />Utility companies notified during the One Call process See attached ticket <br /> List any other utilities requiring notification: <br />None <br />Private Locator Contacted Yes No <br />Client provided utility maps or "as built" drawings showing utilities?Yes No <br />Field Work - This must be completed on site, by staff who have a minimum of one year of field experience <br /> in identifying utilities. Review check list with PM or designee prior to beginning intrusive work. <br />One Call/"811" (Reliable as a line of evidence when working in public right of way or easement) <br />Paint Pin flags/stakes Other None <br />Client Provided Maps/Drawings OR <br />Client Clearance Name(s)/Affiliation(s) <br />Interview(s):Name(s)/Affiliation(s) <br />Did person(s) interviewed indicate depths of any utilities in the subsurface? <br />Yes, depths provided:Did not know or refused to answer <br />Site Inspection (Complete Page 2 & Photo Document Marked Utilities & Utility Structures) <br />Public Records / Maps / Asbuilts <br />Private Locator: (Name and Company) <br />Ground Penetrating Radar (GPR) <br />Radiofrequency (RFLoc) <br />Electromagnetic (EM) <br />Metal Detector <br />Termination Depth ______ft. bgs <br />Potholing / Vacuum Extraction <br />Air-Knife or Hydro-Knife <br />Probing <br />Hand Auguring <br />Other: <br />Marine Locator: (Name and Company) <br />Tips for Successful Utility Location: <br />1. Don't forget to look up <br />2. Be on site with Private Utility Locators <br />3. Ask Private Locators to "confirm" other's markings <br />4. Select alternate/backup locations during clearance process <br />5. Mark out all known utilities. Leave nothing to question <br />6. No hammering - no pickaxes - no digging bars - no shortcutting <br />7. No excessive turning or downward force of hand augers/shovels <br />8. Utilities may run in or directly under asphalt/concrete <br />Soft Dig Methods <br />Plan private utility clearance subcontractor assignments, areas, required clearance equipment, depth of <br />clearance needed, types of utilities. When possible re-clear 811 markings to confirm utility locations. <br />List Soil Boring / Well IDs or Excavation Locations applicable to this clearance checklist: <br /> 3 Reliable Lines of Evidence Required Prior to Starting any Subsurface Intrusive Work <br />Utility Markings Present: <br />Maps/Drawings requested but not provided <br />Additional Comments: <br />THIS FORM MUST BE COMPLETED IN ENTIRETY PRIOR TO BEGINNING ANY INTRUSIVE WORK <br /> Forward LandfillManteca, CA <br />30111270 <br />(15 business days post form completion date) <br />(Review State Requirements)