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Attachment 5 . UTILITY CLEARANCE LOGS Project Location Date Instructions This checklist has to be completed by a SECOR staff member as a safety measure to insure that all underground utility lines, other underground structures as well as above-ground power lines are clearly marked out in the area selected for boring or excavation DRILLING OR EXCAVATION WORK MAY NOT PROCEED UNTIL Cruz Bros. (fill in the name of the utility service) HAS BEEN CONTACTED, FACILITY OPERATORS HAVE LOCATED UTILITIES WITHIN THE FACILITY, UTILITIES AND STRUCTURES ARE MARKED, AND THIS CHECKLIST HAS BEEN COMPLETED As a final measure to prevent hitting buned utilities during drilling, field personnel must hand auger or post hole dig a five-foot hole at the potential drilling location before commencing drilling Alternate techniques such as vacuum excavation are acceptable provided they will not damage any boned utilities Assignment of Responsibility SECOR is responsible for having underground utilities and structures located and marked Preferably, the utility companies themselves should mark out the lines Drilling or Excavation Sites. Attach a map of the property showing the drilling or excavation sites, if sites are widely separated, several map(s) clearly indicating the area(s) checked for underground utilities or underground structures and the location of above-ground power lines Utilities and Structures TYPE PRESENT NT PRESENT HOW MARKED' Petroleum products line Natural izas line Steam line Water line Sewer line Storm drain Telephone cable Electric power line Product tank Septic tank/drain field Other Flags, paint on pavement, wooden stakes, etc Client Approval (with attached map) NAME COMPANY PHONE Name and affiliation of person who marked out underground lines or structures NAME COMPANY PHONE SECOR International Incorporated (SECOR) Field Team Leader Date Completed SECOR International Incorporated 25 Generic HASP 6-14-01