Information
Weather Conditions
-
Date/Time
-
Temperature
- Below 0
- 0-20
- 20-30
- 30-40
- 40-50
- 50-60
- 60-70
- 70-80
- 80-90
- >90
-
Wind (MPH)
-
Skies
-
Precipitation Amount
Daily Report General Information
-
Conducted on
-
Document No.
-
Job #/Cost Code
-
Client / Site
-
Personnel
- Ryan Studaker
- Timothy Goergen
- Jeremy Nelson
- Cody Redfern
- Ricci Yoder
- Cameron Logan
- Chad Lambert
- Terry Bergren
- Calvin Hovde
- Scott Brown
-
Location
-
Prepared by
Additional Weather Observation
-
Weather Observation
-
Time of Change
-
Brief Description of Change
Environmental
-
Environmental Reports
Environmental
24 Hour Incident Response Report
-
Incident Response Report
Incident Report
-
Spill Location
-
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 Time Notified:
-
Date & Time Left the Office:
-
Time Arrived on Site
-
Response Time:
-
Location:
-
Nearest Mile Marker:
-
Strata Job #
-
Client Job #
-
Agency Contact
-
Agency Job #
Material Released
-
Material Released
-
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:
-
Detailed Description of Remedial Actions Taken:
Media
-
Add Drawings/Photo's
Media
-
Picture?
-
Drawing
Project Checklist
-
Pictures?
-
Field Sketch Made?
-
Utilities Located?
-
Safety Plan Signed?
-
Samples Collected
-
MSDS Sheets Reviewed
-
Manifest Completed
-
Waste Secured
-
Time of Signature
-
Signature
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
- Ryan Stuidaker
- Timothy Goergen
- Jeremy Nelson
- Cody Redfern
- Ricci Yoder
- Cameron Logan
- Chad Lambert
- Calvin Hovde
- Scott Brown
- Terry Bergren
-
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
- Clay
- Gravel
- Rock
- Scoria
- Sand
- Top soil
-
Material Hauled From?
-
Add Photo of Truck Haul Sheet
Material Hauled Out
-
Add Load Summary for Contaminated Material Hauled Out?
Contaminated Material Hauled Out
-
Material Hauled To?
- Roughrider Prarie Disposal
- Clean Harbors, Sawyer ND
- Secure Energy, Stanley FAC
- Secure Energy, Keene FAC
- Secure Energy, 13 mi corner
- Wisco
Field Testing
-
Field Testing General Information
General Information
-
Name of Individual Performing Testing Procedures
- Scott Brown
- Timothy Goergen
- Brady Mack
- David May
- Aaron Newman
- Brady Newman
- Mitchell Rau
- Jacob Rylander
- Justin Studaker
- Ryan Sudaker
- Edward Vansickle
- Stacy Zuther
-
Test Results
Test Resullts
-
Photo?
-
Grid Location
-
PID Reading
-
Chloride (ppm)
-
EC (US/CM)
-
Comments
Equipment Usage
-
Excavators, Hydro-Rxcavators, Scraper
Excav. Equipment
-
Description
- Volvo 330
- Cat 316
- Cat 320
- Cat 336
- Mini X
- Hydrovac 12CUYD
- Komatsu 120
- Volvo 140
- Volvo 290
-
Unit #, Name of Operator, Brief Description of Work Performed
Dozers, Motor Grader, Scraper
-
Description
-
Unit #, Name of Operator, Brief Description of Work Performed
Loaders, Skidsteers, Attachments
-
Description
- Volvo L70 Loader
- John Deere 544K loader
- Cat 930M-938M Loader
- Tracked Skidder
- Loader Attachment
- Skidder Attachment
-
Unit #, Name of Operator, Brief Description of Work Performed
Tractors, Compaction Equipment, Misc. Small Tools
-
Description
- 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
Vehicles, CMV's -
Description
- 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
Hazardous Materials Equipment
-
Description
-
Unit #, Name of Operator, Brief Description of Work Performed
Manually Enter Equipment
-
Manually Enter Equipment
-
Unit #, Name of Operator, Brief Description of Work Performed
Time/Material Contract Reporting
-
Time/Material Contract Reporting
T/M Contract
Personnel Log
-
Personnel On-Site
- Scott Brown
- Timothy Goergen
- Brady Mack
- David May
- Aaron Newman
- Brady Newman
- Mitchell Rau
- Jacob Rylander
- Justin Studaker
- Ryan Sudaker
- Edward Vansickle
- Stacy Zuther
-
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
- 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
Dozers, Motor Grader, Scraper
-
Description
- 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
Loaders, Skidsteers, Attachments
-
Description
- Volvo L-70E
- Volvo L150
- Cat 247B
- Rubber Tire Skidsteer
- Tracked Skidsteer
- Skidsteer Attachments
-
Unit #, Name of Operator, Brief Description of Work Performed
Tractors, Compaction Equipment, Misc. Small Tools
-
Description
- 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
Vehicles, CMV's -
Description
- 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
Hazardous Materials Equipment
-
Description
-
Unit #, Name of Operator, Brief Description of Work Performed
Manually Enter Equipment
-
Manually Enter Equipment
-
Unit #, Name of Operator, Brief Description of Work Performed
Materials
-
Materials
T/M Contract Reports
-
Material Type Hauled In
- Clay
- Topsoil
- Sand
- Gravel
- Rock
-
Description
-
Quantity
-
Unit of Measure
- 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
- 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?
-
Todays load count contaminated material hauled out?
Comments
-
Additional Comments
Comments
-
Time
-
Comments
-
Owners Representative Comments
Comments
-
Time
-
Comments
-
Problems/Concerns
Comments
-
Time
-
Comments
Media
-
Add Drawings/Photo's
Media
-
Picture?
-
Drawing
-
Time of Signature
-
Signature