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(Optional)Critical Zone Determination Sketch <br /> Instructions: <br /> _ 1. Create a sketch of the disturbance(in <br /> the space to left or attach)that <br /> contains the following information: <br /> . <br /> a. The disturbance location <br /> b. Surface landmarks and overhead <br /> obstructions(buildings,roads, <br /> overhead lines,etc.) <br /> . <br /> c. Critical landmarks and <br /> Subsurface Structures(tanks, <br /> transformers,wells,racks,etc.) <br /> d. Underground services: <br /> I. Identified in the HASP Site <br /> Service Model <br /> ii. Marked by Public or Private <br /> utility markouts <br /> iii. As relayed by the Contact <br /> Person <br /> iv. Nearest shutoff/isolation <br /> mechanism for each <br /> e. Any surface clues as to potential <br /> - ---- -- underground services Qunction <br /> boxes,drains,disturbed <br /> concrete,signage,etc.) <br /> f. The site property boundary <br /> 2. Use your sketch to mark Critical <br /> Zones(3m or 10 feet)around critical <br /> landmarks and underground <br /> structures/services. <br /> 3. For Excavations,use your sketch to <br /> mark Excavation Buffers(0.6m or 2 <br /> feet)from Subsurface Structures. <br /> 4. If the disturbance location falls inside <br /> the Critical Zone,the preferred course <br /> of action is step out to a safe location <br /> outside a Critical Zone. <br /> 5. Disturbance within a Critical Zone can <br /> only proceed with PIC approval. <br /> ERM Health&Safety Page 2 of 2 Last Rev.:Sept.2009 <br /> English Version <br />