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Subsurface Utility Clearance <br /> Management Program 2.9 <br /> Appendix D -Utility Verification/Site Walkthrough Record <br /> Employee Name: <br /> Date: <br /> Instructions: For each utility suspected at the job site, indicate location on the job site, approximate burial <br /> depth, and means of detecting the utility. Leave blank if that utility is not believed to be present. <br /> Method/ Mark Out <br /> Description of Utility Approx. Instrumentation Utility Owner Indicates <br /> Location Identified Depth used to determine Response (Clear/ <br /> Utility Onsite (bls) Utility Location (Date/Time) Conflict) <br /> Electrical <br /> Lines <br /> Gas Lines <br /> Pipelines <br /> Steam Lines <br /> Water Lines <br /> Sanitary and <br /> Stormwater <br /> Sewer lines <br /> Pressured <br /> Air-Lines <br /> Tank Vent <br /> Lines <br /> Fiber Optic <br /> Lines <br /> Underground <br /> Storage Tanks <br /> Phone Lines/ <br /> Other <br /> *bls - below land surface <br /> 1/2019 Corporate Health and Safety Management Program I ROUX 11 <br />