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�� . . . � . . . .._.. ._..__ � � i < . <br /> f <br /> i2. <br /> I �„ <br /> I <br /> Water Checklist #4 <br /> � w �"�, <br />'` ; A. k�, �: <br /> Date �-7 i � Location `/3�.d d G,ldy Crew Lead 5,/� � <br /> a::;` <br /> '.:�;� <br /> .-; i B. <br /> �riefed? Briefed by <br /> Flaggers Names (YES or NO) <br /> �.�_� <br /> � . <br />,��;� :� i ��`��': I <br />��� _ .:�• , <br /> � Flagger Briefing: j` l= � I <br /> Job Tasks: Flag�er Responsibilities, Emergency Signals, Flagger Radios, Specific work zone hazards, � ,;.,_�; <br /> PPE, Night Lightin�, Planned Equipment Movement, Emergency Escape Plans. <br /> C. Vehicle Inspection Checklist: -" <br /> ' Inspection Comments i <br /> �2 I Driver's Name Equipment # Locatior �ompleted? C ���� <br /> ,�.E <br />� , <br />� � � � S ( �, � <br />� �, � C— U9 � .�;j� <br />� � i „ ' � <br />:�., ; �� /Y� .L 7cx��t 6 ' r' <br />�;�\\` � � , <br /> �� e <br />�k)6�� � t'a <br /> 9.,��Y�µ� I � <br /> ��1 <br /> I I.i: <br /> , ,,,�.;r�� <br /> �__;;. <br /> �.� <br /> • D. Checklist #4 - Routine Part 1 E'`''� � <br />�. YES NO YES NO <br />� 1. Make site visit.before starting work t� 5. In water work -� <br /> Sto wark � <br />�, �a , 2. Define activity, scope, and limits '� ' P <br />> 1� , <br /> ,, ' 3. Review Part 1 BMPs ✓ Contact environmental staff for <br /> review � I <br /> ;, • Permit needed " <br /> . • Evaluate using detailed checklist <br /> • Equipment maintenance `� �, 2, and/or 3 and routine ,/ <br /> � • Disturbed soil _ ,/ checklist <br /> I Waste material removed � <br /> i , <br /> �:;�ill <br /> '�!I; f 6. Location ; <br /> � • Spill kit ✓ <br /> ' � • Part 2 Bh1Ps needed � � � <br /> `� � — z <br /> • Usa checklist #3 and routine <br /> ,-�n� checklist � 3 _ <br /> 4. Is ervironmental staft required? 4 <br /> NO - continue maintenance � 5 � <br /> YES - contact environmental staff for <br /> review <br /> 5:\rCar.unan\�N�+I\�=TS\%o os-aoo3\Chccklista_Wal v.dac <br />