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AARCADIS <br />THIS FORM MUST BE COMPLETED IN ENTIRETY PRIOR TO BEGINNING ANY INTRUSIVE WORK <br />Project: Forward Landfil I Manteca, CA <br />Project Number: SM010309.0000 <br />Form Completion Date: Form Expiration Date: <br />Pre -Field Work (15 business days post form completion date) <br />Required: One Call or "811" notified 48-72 hours in advance of work? #: <br />Ticket Expiration Date Review State Requirements) <br />Utility companies notified during the One Call process See attached ticket <br />List an other utilities requiring notification: <br />None <br />Private Locator Contacted =Yes =No <br />Plan private utility clearance subcontractor assignments, areas, required clearance equipment, depth of <br />clearance needed, types of utilities. When possible re -clear 811 markings to confirm utility locations. <br />Client provided utility maps or "as built" drawings showing utilities? =Yes =No <br />Field Work - This must be completed on site, by staff who have a minimum of one year of field experience <br />in identifying utilities. Review check list with PM or designee prior to beginning intrusive work. <br />List Soil Boring / Well IDs or Excavation Locations applicable to this clearance checklist: <br />3 Reliable Lines of Evidence Required Prior to Starting any Subsurface Intrusive Work <br />=One Call/"811" (Reliable as a line of evidence when working in public right of wa or easement <br />Utility Markings Present: Paint =Pin flags/stakes Other Mone <br />Client Provided Maps/Drawings OR Maps/Drawings requested but not provided <br />Client Clearance Name(s)/Affiliation(s) <br />Interview(s): Name(s)/Affiliation(s) <br />Did person(s) interviewed indicate depths of any utilities in the su su ace. <br />=Yes, depths provided: =Did not know or refused to answer <br />Additional Comments: <br />Site Inspection (Complete Page 2 & Photo Document Marked Utilities & Utility Structures) <br />Public Records / Maps / Asbuilts <br />Private Locator: (Name and Company) <br />Ground Penetrating Radar (GPR) <br />Radiofrequency (RFLoc) <br />Tips for Successful Utility Location: <br />Electromagnetic (EM) <br />1. Don't forget to look up <br />Metal Detector <br />2. Be on site with Private Utility Locators <br />Soft Dig Methods <br />3. Ask Private Locators to "confirm" other's markings <br />Termination Depth ft. bgs <br />4. Select alternate/backup locations during clearance process <br />Potholing / Vacuum Extraction <br />5. Mark out all known utilities. Leave nothing to question <br />Air -Knife or Hydro -Knife <br />6. No hammering - no pickaxes - no digging bars - no shortcutting <br />7. No excessive turning or downward force of hand augers/shovels <br />Probing <br />8. Utilities may run in or directly under asphalt/concrete <br />Hand Auaurino <br />Other: <br />0 "Marine Locator: (Name and Company) <br />