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U . S . Department of Agriculture <br /> Natural Resources Conservation Service Hazardous Materials Field Inspection Checklist <br /> HAZARDOUS MATERIALS FIELD INSPECTION CHECKLIST j <br /> A. BACKGROUND INFORMATION <br /> Clear Form <br /> NRCS PROGRAM LANDOWNER NAME <br /> c: <br /> PROPERTY ADDRESS NUMBER OF ACRES <br /> NEST APPLICATION NUMBER COUNTY STATE <br /> FIELD INSPECTOR' S NAME & TITLE DATE INSPECTED <br /> B. INSTRUCTIONS : <br /> • For each question, indicate if you find any evidence of past or present hazardous materials . <br /> • For any suspected evidence found, display the location on the parcel map and attach photographic evidence as an <br /> addendum to this document . <br /> • If you need more room to explain your findings attach additional sheets . <br /> • When complete, attest that a field inspection has been completed and that to the best of your knowledge the <br /> information included is accurate . <br /> C. Field Conditions . Onsite Nearby None <br /> 1 . Dumps or landfills (especially with drums/containers) 7 <br /> 2. Other debris : household or farm waste <br /> 3 . Fills (possible cover for dumps) ? Y g <br /> 4. Unusual chemical odorsP7 <br /> 5. Above/below ground storage tanks <br /> P71 <br /> 6. Buildings : chemical storage, equipment repair solvents <br /> 7. Structures : evidence of asbestos �? <br /> F IP7 <br /> 8. Vegetation different from surrounding area for no apparent reasonFlll <br /> stressed or dead bare round <br /> (e . g. , ground) <br /> 9. " Sterile " or modified water bodies F F F1 <br /> 10. Oil seeps, stained ground, discolored stream banks �I <br /> 11. Unnatural characteristics of water : oil slicks, unusual color, etc . <br /> F <br /> 12. Spray operation base : air strip , equipment parking area chemicalF. P7111 <br /> staging, storage, and mixing areas <br /> 13. Machinery repair areas FFill <br /> 14. Pipelines , power lines , gas lines <br /> 15. Oiled or formerly oiled roads <br /> 16. Mounted transformers - evidence of leakage <br /> 17. Any mining activity or mining residue : past, present, or future <br /> r' <br /> 18. Wastewater treatment equipment, septic system, sewage lagoons <br /> 1 <br />