Chesapeake Energy WV Consent Decree Assurance

• Location Name:

• Pad Number:

• County:

• Location:
  Address

• Date of Inspection:

  Date

• Prepared by:

• Personnel:

Location Entrance

• Well signs present

  Yes

  No

  N/A

• State Permit Present

  Yes

  No

  N/A

• ESCGP-1 Permit (PA) Present

  Yes

  No

  N/A

• Crime Watchers Sign Present

  Yes

  No

  N/A

• 911 Sign With Address Present

  Yes

  No

  N/A

• No Trespassing Sign Present

  Yes

  No

  N/A

• Mailbox Present

  Yes

  No

  N/A

• Site Plans Present

  Yes

  No

  N/A

• PPC/ERP (PA) In Tube

  Yes

  No

  N/A

• Gate Present/Good Condition

  Safe

  At Risk

  N/A

Limits of Disturbance

• Was all construction activity kept within the L.O.D?

  Safe

  At Risk

  N/A

• Are there any known water sources within the L.O.D. that have been affected by construction?

  Safe

  At Risk

  N/A

• Was the entire L.O.D. walked?

  Yes

  No

  N/A

Erosion and Sediment Controls

• E&S control features installed?

  Yes

  No

  N/A

• All in working order?

  Yes

  No

  N/A

General Site Overview

• Fuel properly contained?

  Yes

  No

  N/A

• Roadway clear of mud and debri?

  Yes

  No

  N/A

• All workers wearing proper PPE? (Hard hats, steel toe boots, etc.)

  Yes

  No

  N/A

• Comments

• Signature:

  Sign