Strata Corporation - Daily Field Report Ver 2.3 11/8/13 - Local - duplicate

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:

• Strata 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 Scott Brown Timothy Goergen Brady Mack David May Aaron Newman Brady Newman Mitchell Rau Jacob Rylander Justin Studaker Ryan Sudaker Edward Vansickle Stacy Zuther

  • 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

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?

Field Testing

• Field Testing General Information

General Information

• Name of Individual Performing Testing Procedures

  Select Scott Brown Timothy Goergen Brady Mack David May Aaron Newman Brady Newman Mitchell Rau Jacob Rylander Justin Studaker Ryan Sudaker Edward Vansickle Stacy Zuther

  • 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?

  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 Scott Brown Timothy Goergen Brady Mack David May Aaron Newman Brady Newman Mitchell Rau Jacob Rylander Justin Studaker Ryan Sudaker Edward Vansickle Stacy Zuther

  • 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

  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