L&S Site Contractor

Weather Conditions

• Date/Time

  Date

• Temperature

  Select Below 0 0-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 >90

  • Below 0
  • 0-20
  • 20-30
  • 30-40
  • 40-50
  • 50-60
  • 60-70
  • 70-80
  • 80-90
  • >90

• Wind (MPH)

  0-5

  5-10

  10-15

  15-20

  >20

• Skies

  Cloudy/Overcast

  Partly Sunny

  Clear

  Rain

  Snow

• Precipitation Amount

Daily Report General Information

• Conducted on

  Date

• Document No.

• Job #/Cost Code

• Client / Site

• Personnel

• Location
  Address

• Prepared by

Additional Weather Observation

Weather Observation

• Time of Change

  Date

• Brief Description of Change

Environmental

• Environmental Reports

Environmental

24 Hour Incident Response Report

• Incident Response Report

Incident Report
• Spill Location
  Address

• Property Owner's Name & Phone Number

• Client's Name & Phone #

• Transporter

• State Agency

Incident Notification

• Incident Reported By:

• State/Fed Agencies Notified:

• Incident Date & Time:

  Date

• Date Time Notified:

  Date

• Date & Time Left the Office:

  Date

• Time Arrived on Site

  Date

• Response Time:

• Location:
  Address

• Nearest Mile Marker:

• L&S Job #

• Client Job #

• Agency Contact

• Agency Job #

Material Released

• Material Released

  Liquid

  Solid

  Gas

• Chemical & Volume Released

• Duration of Release

• Type of Release

• Detailed Description of Environmental Impacts

• Waterways Impacted:

Container

• Type:

• Capacity

• Container Unit #

• Generator:

• Transporter:

• Driver:

• Detailed Description of incident: (cause of release, how detected, contributing factors)

• Surrounding Land Use:

  Commercial

  Residential

  Agricultural

  Undevloped

• Detailed Description of Remedial Actions Taken:

Media

• Add Drawings/Photo's
  

Media

• Picture?

  Media

• Drawing

  Drawing

Project Checklist

• Pictures?

• Field Sketch Made?

• Utilities Located?

• Safety Plan Signed?

• Samples Collected

• MSDS Sheets Reviewed

• Manifest Completed

• Waste Secured

• Time of Signature

  Date

• Signature

  Sign

Daily Report for Hazmat Response

• Daily Report for HAZ MAT

HAZ MAT RPRT

• Job #

• Cost Code

• Project Name

• Description of Work Performed:

• Sampling Performed

• Personnel Log

Personnel

• Personnel On-Site

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Travel Time Hrs

• On-Site Hrs

• Manually Enter Additional Personnel

• Personnel Log

Personnel

• Name

• Company

• Travel Time Hrs

• On-Site Hrs

Load Summary

Material Hauled In

• Add Load Summary for Material Hauled In?

Material Hauled In

• Material Type Hauled In

  Select Clay Topsoil Sand Gravel Rock

  • Clay
  • Topsoil
  • Sand
  • Gravel
  • Rock

• Material Hauled From?

• Today's load count hauled in

• Add Photo of Truck Haul Sheet

  Media

Material Hauled Out

• Add Load Summary for Contaminated Material Hauled Out?

Contaminated Material Hauled Out

• Material Hauled To?

  Clean Harbors

  Indian Hills

• Todays load count contaminated material hauled out?

Field Testing

• Field Testing General Information

General Information

• Name of Individual Performing Testing Procedures

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Test Results

Test Resullts

• Photo?

  Media

• Grid Location

• PID Reading

• Chloride (ppm)

• EC (US/CM)

• Comments

Equipment Usage

• Excavators, Hydro-Rxcavators, Scraper

Excav. Equipment

• Description

  Select Cat 420 Rubber Tire Back Hoe 1 Hyd Breaker PC 220 LR Shaker Bucket Vermeer Trencher Volvo 240 Volvo 330 Volvo 360 Volvo Excavator EC140BLC Hydro 12 cu yd Hydro - 6 cu yd VACTRON

  • Cat 420 Rubber Tire Back Hoe 1
  • Hyd Breaker
  • PC 220 LR
  • Shaker Bucket
  • Vermeer Trencher
  • Volvo 240
  • Volvo 330
  • Volvo 360
  • Volvo Excavator EC140BLC
  • Hydro 12 cu yd
  • Hydro - 6 cu yd
  • VACTRON

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Dozers, Motor Grader, Scraper

• Description

  Select D6N/M D6R D8N D8R D8T JD 650 JD 750 JD 850 D41 D61 140H 163H PLWWNGATTCHMNT

  • D6N/M
  • D6R
  • D8N
  • D8R
  • D8T
  • JD 650
  • JD 750
  • JD 850
  • D41
  • D61
  • 140H
  • 163H
  • PLWWNGATTCHMNT

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Loaders, Skidsteers, Attachments

• Description

  Select Volvo L-70E Volvo L150 Cat 247B Rubber Tire Skidsteer Tracked Skidsteer Skidsteer Attachments

  • Volvo L-70E
  • Volvo L150
  • Cat 247B
  • Rubber Tire Skidsteer
  • Tracked Skidsteer
  • Skidsteer Attachments

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Tractors, Compaction Equipment, Misc. Small Tools

• Description

  Select John Deer 4 Wheel Drive John Deere 2 Wheel Dr Tractor W/Attachments Generators > 200KW Hydro Mulch Trailer Jumping Jacks/Plate Tamper Light Plant/Day Polaris ranger Pressure Washer Trailer Small Generator Volvo Off Road Truck

  • John Deer 4 Wheel Drive
  • John Deere 2 Wheel Dr
  • Tractor W/Attachments
  • Generators > 200KW
  • Hydro Mulch Trailer
  • Jumping Jacks/Plate Tamper
  • Light Plant/Day
  • Polaris ranger
  • Pressure Washer Trailer
  • Small Generator
  • Volvo Off Road Truck

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Vehicles, CMV's


• Description

  Select Crew Pickup Freightliner Tri Axle End Dump Lowboy Semi Side Dump Tandem Dump Truck Vac Truck Water Truck

  • Crew Pickup
  • Freightliner Tri Axle End Dump
  • Lowboy
  • Semi Side Dump
  • Tandem Dump Truck
  • Vac Truck
  • Water Truck

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Hazardous Materials Equipment

• Description

  Boom Trailer/Day

  Hazmat ER Trailer/Day

  Lab Trailer/Day

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Manually Enter Equipment

• Manually Enter Equipment

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Time/Material Contract Reporting

• Time/Material Contract Reporting

T/M Contract

Personnel Log

• Personnel On-Site

  Select Cameron Lawing Nate Lawing Jeff Massey Zane Ray Greg Massey Steve Pedersen Robin Lawing Paul Lytle Mike Ash Stewart McCarson

  • Cameron Lawing
  • Nate Lawing
  • Jeff Massey
  • Zane Ray
  • Greg Massey
  • Steve Pedersen
  • Robin Lawing
  • Paul Lytle
  • Mike Ash
  • Stewart McCarson

• Travel Time Hrs

• On-Site Hrs

• Manually Enter Additional Personnel

• Personnel Log

Personnel

• Name

• Company

• Travel Time Hrs

• On-Site Hrs

Equipment Usage

• Excavators, Hydro-Rxcavators, Scraper

Excav. Equipment

• Description

  Select Cat 420 Rubber Tire Back Hoe 1 Hyd Breaker PC 220 LR Shaker Bucket Vermeer Trencher Volvo 240 Volvo 330 Volvo 360 Volvo Excavator EC140BLC Hydro 12 cu yd Hydro - 6 cu yd VACTRON

  • Cat 420 Rubber Tire Back Hoe 1
  • Hyd Breaker
  • PC 220 LR
  • Shaker Bucket
  • Vermeer Trencher
  • Volvo 240
  • Volvo 330
  • Volvo 360
  • Volvo Excavator EC140BLC
  • Hydro 12 cu yd
  • Hydro - 6 cu yd
  • VACTRON

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Dozers, Motor Grader, Scraper

• Description

  Select D6N/M D6R D8N D8R D8T JD 650 JD 750 JD 850 D41 D61 140H 163H PLWWNGATTCHMNT

  • D6N/M
  • D6R
  • D8N
  • D8R
  • D8T
  • JD 650
  • JD 750
  • JD 850
  • D41
  • D61
  • 140H
  • 163H
  • PLWWNGATTCHMNT

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Loaders, Skidsteers, Attachments

• Description

  Select Volvo L-70E Volvo L150 Cat 247B Rubber Tire Skidsteer Tracked Skidsteer Skidsteer Attachments

  • Volvo L-70E
  • Volvo L150
  • Cat 247B
  • Rubber Tire Skidsteer
  • Tracked Skidsteer
  • Skidsteer Attachments

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Tractors, Compaction Equipment, Misc. Small Tools

• Description

  Select John Deer 4 Wheel Drive John Deere 2 Wheel Dr Tractor W/Attachments Generators > 200KW Hydro Mulch Trailer Jumping Jacks/Plate Tamper Light Plant/Day Polaris ranger Pressure Washer Trailer Small Generator Volvo Off Road Truck

  • John Deer 4 Wheel Drive
  • John Deere 2 Wheel Dr
  • Tractor W/Attachments
  • Generators > 200KW
  • Hydro Mulch Trailer
  • Jumping Jacks/Plate Tamper
  • Light Plant/Day
  • Polaris ranger
  • Pressure Washer Trailer
  • Small Generator
  • Volvo Off Road Truck

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Vehicles, CMV's


• Description

  Select Crew Pickup Freightliner Tri Axle End Dump Lowboy Semi Side Dump Tandem Dump Truck Vac Truck Water Truck

  • Crew Pickup
  • Freightliner Tri Axle End Dump
  • Lowboy
  • Semi Side Dump
  • Tandem Dump Truck
  • Vac Truck
  • Water Truck

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Hazardous Materials Equipment

• Description

  Boom Trailer/Day

  Hazmat ER Trailer/Day

  Lab Trailer/Day

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Manually Enter Equipment

• Manually Enter Equipment

• Unit #, Name of Operator, Brief Description of Work Performed

• Approximate No. of Hours of Usage

Materials

• Materials

T/M Contract Reports

• Material Type Hauled In

  Select Clay Topsoil Sand Gravel Rock

  • Clay
  • Topsoil
  • Sand
  • Gravel
  • Rock

• Description

• Quantity

• Unit of Measure

  Select Hrs. Lump Sum Lineal Feet Sq. Ft. Sq. Yd. Cu. Yd. Tons Loads M Gals

  • Hrs.
  • Lump Sum
  • Lineal Feet
  • Sq. Ft.
  • Sq. Yd.
  • Cu. Yd.
  • Tons
  • Loads
  • M Gals

Load Summary

Material Hauled In

• Add Load Summary for Material Hauled In?

Material Hauled In

• Material Type Hauled In

  Select Clay Topsoil Sand Gravel Rock

  • Clay
  • Topsoil
  • Sand
  • Gravel
  • Rock

• Material Hauled From?

• Today's load count hauled in

Material Hauled Out

• Add Load Summary for Contaminated Material Hauled Out?

Contaminated Material Hauled Out

• Material Hauled To?

  Clean Harbors

  Indian Hills

• Todays load count contaminated material hauled out?

Comments

• Additional Comments

Comments

• Time

  Date

• Comments

• Owners Representative Comments

Comments

• Time

  Date

• Comments

• Problems/Concerns

Comments

• Time

  Date

• Comments

Media

• Add Drawings/Photo's
  

Media

• Picture?

  Media

• Drawing

  Drawing

• Time of Signature

  Date

• Signature

  Sign