DSHW-2024-008799

ENVIRONMENTAL CLEANUP PROGRAM – SITE VISIT REPORT
SITE NAME: DATE:
LOCATION:
PROJECT MANAGER:
SITE STATUS
Active Investigation
Ongoing Cleanup Activities
Confirmation Sampling
Long-term Institutional Controls in-place (Site
Management Plan &/or Environmental Covenant)
Long-term Groundwater Monitoring
Closed w/ No More Work Needed
OTHER (describe):
PURPOSE OF SITE VISIT
Drive-by (windshield survey)
Sample Observation &/or Collection
Site Investigation
Cleanup Activities Inspection
Confirm Current Land Usage
Confirm Cleanup Completed
Confirm Integrity of Engineering Controls
Confirm SMP is Being Complied With
Post-Closure Permit Verification
Document Change in Land Usage
OTHER (describe)
FIELD OBSERVATIONS:
SAMPLE COLLECTION
Were Environmental Samples Collected by the Consultant per the approved Sampling & Analysis Plan?
YES NO
COMMENTS:
Wayne County Maintenance Building October 4, 2024
295 North 100 West, Loa
J. Olsen
Is the Work Being Performed in a Manner Consistent with the Approved Workplan(s)?
YES NO
COMMENTS:
CURRENT LAND USAGE
Residential
Commercial
Industrial
Mixed Commercial w/ Residential
Under Construction &/or Development
OTHER (Describe):
FUTURE LAND USAGE
Residential Mixed Commercial w/ Residential
Commercial Other: (describe below)
Industrial
POST-CLEANUP SITE VISITS
Is the Completed Cleanup Remedy Still Protective Based on Current Land Use?
YES NO
COMMENTS:
LONG-TERM INSTITUTION CONTROL(S) VERIFICATION
Are Components or Restrictions of the SMP &/or EC Currently Being Complied with?
YES NO
COMMENTS:
SITE VISIT CONCLUSIONS
RECOMMENDATIONS
ATTACHMENTS (PHOTOS, MAPS, FIGURES, TABLES, etc.) YES NO
SIGNATURE: