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UTILITIES AND STR_ UCTURES CBECKLIST <br /> ' Project: Soil-Vapor Intrusion Survey Prepared by- Paul Anderson <br /> ' Location: 1444 South Lincoln Street Stockton,CA 95206 Date: January 30,2009 <br /> Instructions: This checklist has to be completed by a PSC staff member as a safety measure to ensure that all <br /> underground utility lines,other underground structures as well as above-ground power lines are clearly marked out in <br /> the area selected for boring or excavation. DRILLING OR EXCAVATION WORK MAY NOT PROCEED <br /> UNTIL LINES ARE MARKED AND THIS CHECKLIST HAS BEEN COMPLETED. Arrangements for <br /> underground utility markouts are best made at the time of the preliminary site visit to allow client and/or utility <br /> company sufficient time. Keep completed checklist and maps onsite;send copy to Project Manager. <br /> _ Client Approval: Client is responsible for having underground utilities and structures located and marked. <br /> Preferably,the utilities themselves should mark out the lines. <br /> ' State Utility Call-In:Underground Service Alert (USA) <br /> Phone Number: (800) 642-2444 <br /> Ticket Number: 021369 <br /> Drilling or Excavation Sites: Attach a map of the property showing the proposed drilling or excavation site(or if <br /> sites are widely separated, several maps) clearly indicating the area(s) checked for underground utIlities or <br /> underground structures and the location of above-ground power lines. <br /> UTH,ITIES AND STRUCTURES Com lete on site <br /> Nfineuct <br /> NOT PRESENT P"RESENT MARKED' <br /> ct line <br /> Storm drain <br /> Telentank <br /> Elec <br /> Prod <br /> Se tldOve <br /> Flags,paint on pavement,wooden stakes,etc. <br /> Name and affiliation of third-party person who marked out underground lines or structures. <br /> Dave Ferguson Subdynamic Locating Services,Inc. (209)613-9369 <br /> (Name) (Organization) (Phone) <br /> t <br /> f Emergency Procedures <br /> Person at site or facility to contact in case of emergency: <br /> j, 1. See Emergency Contact Page Phone: <br /> 2. Phone: <br /> Fire Department Phone: Ambulance Phone: <br /> Utility Phone: Utility Phone: <br /> I' Directions to nearest hospital(describe on back or attach map). <br />