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00 ARCADIS for rtaturalantl <br /> hunt assets <br /> THIS FORM MUST BE COMPLETED IN ENTIRETY PRIOR TO BEGINNING ANY INTRUSIVE WORK <br /> Project: Forward LandfiIIManteca, CA <br /> Project Number: 30158195 <br /> Form Completion Date: Form Expiration Date: <br /> (15 business days post form completion date) <br /> Pre-Field Work <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 way 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 subsurface? <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) Tips for Successful Utility Location: <br /> Electromagnetic (EM) 1. Don't forget to look up <br /> Metal Detector 2. Be on site with Private Utility Locators <br /> Soft Dig Methods 3.Ask Private Locators to"confirm"other's markings <br /> Termination Depth ft. bgs 4. Select alternate/backup locations during clearance process <br /> Potholing/Vacuum Extraction 5. Mark out all known utilities. Leave nothing to question <br /> 6. No hammering-no pickaxes-no digging bars-no shortcutting <br /> Air-Knife or Hydro-Knife 7. No excessive turning or downward force of hand augers/shovels <br /> Probing 8. Utilities may run in or directly under asphalt/concrete <br /> Hand Auguring <br /> Other: <br /> Marine Locator: (Name and Company) <br />