Southern Company Engineering Survey: Addendum To IX Engineering Survey

• Client:

• Project Name:

• Location
  Address

• Conducted on

  Date

• Prepared by

• Competent Person Signature:

  Sign

• Job Contact:

• Telephone Number:

Structure

• Name of Structure:

• Year Built:

• Description of Structure:

• Has the structure been damaged by fire, flood, explosion, or other causes?

  YES

  NO

  N/A

• Potential hazards (for example, collapse, structural failure, explosive material)?

• Any unique site/structural conditions?

Dimensions

• Length

• Width

• Height

Materials

• Foundation

• Floors

• Walls

• Roof

• Equipment To Be Used:

• Disposal Plan:

Hazardous Energy

• Did the structure use any of these utilities?

• Electrical Power/Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Natural Gas Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Water Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Sewer Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Fiber-Optic Cables?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Phone Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Telemetering Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Oxygen Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

• Other Utility Lines?

  YES

  NO

  N/A

• If YES, what is the operational state of the utility?

  Active

  Disconnected

• Verified?

  YES

  NO

• If active, who will disconnect, cap, air-gap, or relocate, and when?

Underground Utilities

• Is there going to be any excavation work?

  YES

  NO

• Has a Locate Ticket been opened?

  YES

  NO

• Date ticket was opened:

  Date

• Ticket Number

• Are underground services marked?

  YES

  NO

Chemicals

• Are any of these hazards present?

• Underground storage tanks (USTs)?

  YES

  NO

  N/A

• If YES, what is the status of the hazardous chemical/material?

  PRESENT

  DRAINED

  PURGED

• Verified?

  YES

  NO

• If hazards are present, who will mitigate the hazards prior to demolition?

• Vessels/storage tanks?

  Yes

  No

  N/A

• If YES, what is the status of the hazardous chemical/material?

  PRESENT

  DRAINED

  PURGED

• Verified?

  YES

  NO

• If hazards are present, who will mitigate the hazards prior to demolition?

• Process piping (chemical)?

  YES

  NO

  N/A

• If YES, what is the status of the hazardous chemical/material?

  PRESENT

  DRAINED

  PURGED

• Verified?

  YES

  NO

• If hazards are present, who will mitigate the hazards prior to demolition?

• Hydraulic piping/reservoirs?

  YES

  NO

  N/A

• If YES, what is the status of the hazardous chemical/material?

  PRESENT

  DRAINED

  PURGED

• Verified?

  YES

  NO

• If hazards are present, who will mitigate the hazards prior to demolition?

Chemical/Environmental Hazards

• Are these chemical/environmental hazards present?

• Are asbestos containing materials present?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• Any Freon or other refrigerants?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• Lead-containing materials?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• PCB's?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• Mercury devices?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• Radiation sources?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

• Any additional hazardous materials?

  YES

  NO

  N/A

• If YES, what is the plan for removal of these materials? Give details on location and description of action taken or to be taken:

Pre-Existing Damage

• Are any of these hazards present?

• Is there any preexisting structural damage?

  YES

  NO

  N/A

• Location/Description:

• Is shoring or bracing required?

  YES

  NO

• Location/Description:

Personnel

• Are personnel exposed to the following hazards?

• Pit/trenches?

  YES

  NO

  N/A

• Location/Description:

• Fall Hazards?

  YES

  NO

  N/A

• Location/Description:

• Holes?

  YES

  NO

  N/A

• Location/Description:

Safety Exposures

• Fire hazards?

  YES

  NO

  N/A

• Location/Description:

• Combustibles?

  YES

  NO

  N/A

• Location/Description:

• Process hazards?

  YES

  NO

  N/A

• Location/Description:

• Basements?

  YES

  NO

  N/A

• Location/Description:

• Elevators?

  YES

  NO

  N/A

• Location/Description:

• Party walls?

  YES

  NO

  N/A

• Location/Description:

• Bulkheads?

  YES

  NO

  N/A

• Location/Description:

• Confined Spaces?

  YES

  NO

  N/A

• Location/Description:

• Additional Safety Exposures?

  YES

  NO

  N/A

• Location/Description:

Safety/Protection Measures

• During demolition operations, are safety or protective measures needed for the following?

• Adjacent walkways/sidewalks?

  YES

  NO

  N/A

• Location/Description:

• Adjacent roadways?

  YES

  NO

  N/A

• Location/Description:

• Adjacent buildings?

  YES

  NO

  N/A

• Location/Description:

• Public Exposure?

  YES

  NO

  N/A

• Location/Description:

• Live utilities?

  YES

  NO

  N/A

• Location/Description:

• Manholes?

  YES

  NO

  N/A

• Location/Description:

• Storm-water runoff?

  YES

  NO

  N/A

• Location/Description:

• Temporary support, shoring, or bracing?

  Yes

  No

  N/A

• Location/Description:

• Adjacent retaining walls or slopes?

  YES

  NO

  N/A

• Location/Description:

• Additional items?

  YES

  NO

  N/A

• Location/Description:

Emergency Information

• EMS

• Name of Agency:

• Phone Number:

• Fire

• Name of Agency:

• Phone Number:

• Police

• Name of Agency:

• Phone Number:

• Site Superintendent

• Name of Agency:

• Phone Number:

• Owner's Representative

• Name of Agency:

• Phone Number:

• Nearest Urgent Medical Facility

• Address:

• Directions:

• Map:

  Media

• Nearest Hospital

• Address:

• Directions:

• Map:

  Media

Signatures

• Contractor Representative

• Contractor Representative

  Sign

• Select date

  Date

• Owner's Representative

• Owner's Representative

  Sign

• Select date

  Date