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Home My WebLink AboutDSHW-2024-005827ENVIRONMENTAL CLEANUP PROGRAM – SITE VISIT REPORT SITE NAME: _________________________________________ DATE: ______/_______/___________ EPA ID #: _________________________________________ UTCA ID#: ______________________ LOCATION: ___________________________________________________________________________ PROJECT MANAGER: ____________________________________________________________________ SITE STATUS ___ Long-term Institutional Controls in-place (Site Management Plan &/or Environmental Covenant) ___ Long-term Groundwater Monitoring ___ Closed w/ No More Work Needed ___ Active Investigation OTHER (describe): PURPOSE OF SITE VISIT ___ Confirm Cleanup Completed ___ Confirm Integrity of Engineering Controls ___ Confirm SMP is Being Complied With D2# for SMP: DSHW-________-_______________ ___ Post-Closure Permit Verification ___ Document Change in Land Usage ___Drive-by (windshield survey) ___Sample Observation &/or Collection ___Site Investigation ___Cleanup Activities Inspection ___Confirm Current Land Usage OTHER (describe): FIELD OBSERVATIONS: SAMPLE COLLECTION Were Environmental Samples Collected per the approved Sampling & Analysis Plan? YES ___ NO ___ N/A ___ COMMENTS: Ongoing Cleanup Activities Confirmation Sampling Is the Work Being Performed in a Manner Consistent with the Approved Workplan(s)? YES ___ NO ___ N/A ___ Unknown (Drive-By Inspection Only) ___ COMMENTS: CURRENT LAND USAGE ___ Residential ___ Commercial ___ Industrial ___ Mixed Commercial w/ Residential ___ Under Construction &/or Development ___ Other: __________________________________ COMMENTS: FUTURE LAND USAGE ___ Residential ___ Mixed Commercial w/ Residential ___ Commercial ___ Other: (describe below) ___ Industrial ___ Unknow at this time COMMENTS: POST-CLEANUP SITE VISITS Is the Completed Cleanup Remedy Still Protective Based on Current Land Use? YES ___ NO ___ Unknown (Drive-By Inspection Only) ___ COMMENTS: LONG-TERM INSTITUTION CONTROL(S) VERIFICATION Are Components or Restrictions of the SMP &/or EC Currently Being Complied with? YES ___ NO ___ Unknown (Drive-By Inspection Only) ___ COMMENTS: SITE VISIT CONCLUSIONS RECOMMENDATIONS ATTACHMENTS (PHOTOS, MAPS, FIGURES, TABLES, etc.) YES ___ NO ___ SIGNATURE: