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A=COM Part 1 and Part 2 shall be completed prior to any intrusive subsurface work. DO NOT DISTURB GROUND if a "No"or "N/A"answer to any of the Part 1 questions has not been initialed as authorized by the AECOM Manager. Any variance from these procedures requires approval of the Vice President of the applicable business group. Yes No N/A 6. Visual verification that each of the proposed locations does not lie on a line connecting two ❑ ❑ ❑ similar manhole covers(e.g. sanitary sewer or storm drain)? 7. Visual verification that the ground in the vicinity of each of the proposed subsurface locations has not subsided, been excavated and patched,give the appearance it may be covering a former trench (e.g. linear cracks, sagging curbs, linear re-pavements, etc.)and ❑ ❑ ❑ does not lie on a line with any water, gas, electrical meters, utility cleanouts,or other utility boxes in the surrounding areas? IV. Site Walk 1. Has a site walk been performed that includes the following: ❑ ❑ ❑ a. Reviewing all planned intrusive locations? ❑ ❑ ❑ b. Adjusting locations away from subsurface utilities and installations? ❑ ❑ ❑ c. Determining the appropriate utility clearance activities for each location? ❑ ❑ ❑ d. Determining the presence and location of overhead utilities and obstructions? ❑ ❑ ❑ e. Walk around perimeter of the site to observe physical hazards? ❑ ❑ ❑ f. Includes 50 feet(15.2 meters)from perimeter of the site to observe physical hazards ❑ ❑ ❑ and 50 feet(15.2 meters)radius from each proposed subsurface location? V. Proposed Subsurface Investigation Locations* 1. Are all of the proposed subsurface locations at least 5 feet(1.5 meters)from any identified ❑ ❑ ❑ subsurface utility? 2. Are all of the proposed subsurface locations at least 7 feet(2.1 meters)from the pad ❑ ❑ ❑ surrounding any underground storage tanks (USTs)shown on the Site Plan? 3. Are all of the proposed subsurface locations at least 5 feet(1.5 meters)from any subsurface ❑ ❑ ❑ utilities shown on the Public Right-of-Way street improvements? "These set back distances are a minimum;government regulations and utility requirements may dictate a greater set back distance. VI. Utility Clearance Investigation Location Confirmation* 1. Have the hand clearance/tolerance zones of subsurface locations been observed and utilities exposed through the use of non-destructive techniques as follows? Hand/non- destructive technique clearance should be extended if locations of deep utilities and ❑ ❑ ❑ structures are not known. In non-urban areas hand clearing should be conducted if possible and according to local requirements. a. For soil borings/monitoring wells; excavated to a minimum of 5 feet(1.5 meters)below ❑ ❑ ❑ ground surface using non-mechanical methods? b. For soil gas sampling; excavated to 2 foot(0.6 meter) below grade or below the bottom ❑ ❑ ❑ of a concrete floor prior to the installation of soil gas sample probe points? Exceptions to requirements of the utility clearance process, as permitted by the applicable jurisdiction, include the following: • Sites where extensive utility mapping(e.g.geophysical survey)has been completed and/or where extensive activities have already been performed. • Locations where facility layout is well documented and understood. • Sites or portions of large sites where utilities are known not to exist currently or to not have ever existed throughout the life of the facility,property or site. Underground Utilities&Subsurface Installations Clearance Checklist(S3AM-331-FM1) Revision 1 September 30,2020 PRINTED COPIES ARE UNCONTROLLED. CONTROLLED COPY IS AVAILABLE ON COMPANY INTRANET. Page 2 of 4