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| Baseline Prepared by: | Author: | Firm: | |
| County: | Route: | Item No.: | |
| Description: | |||
| Prime Consultant: | |||
| Due Date: | Submittal Date: | Submittal Draft #: | Approval Date: |
Baseline Prepared by: Name of author/firm that prepared the study.
County: Name of county(ies) within which the project is located.
Route: Name of highway for which the project is intended. Include route designation and number as applicable (i.e. US 60, Winchester Rd.)
Item No.: Item number as it appears in the contract and Six Year Plan which corresponds with the project.
Description: Official description of the project as it appears in the Six Year Plan.
Prime Consultant: Name of the Phase I Design and Environmental Consultant (prime contract holder) for the project.
Due Date: Date that the project is due as agreed upon in contract negotiation.
Date of Submittal/Submittal Draft Number: Date of submittal and draft being submitted (1st, 2nd, 3rd) in appropriate sections.
Approval Date: Date baseline is approved by DEA (DEA use only).
For "Required" column: X indicates all applicable areas of focus (DEA's responsibility).
For "Completed" column: use Y for yes and NA for not applicable as necessary (Consultant's responsibility).
For "DEA" Column: DEA will use X for all areas that adequately address concerns, and "I" for those that are insufficient in coverage.
"Comment" page: Discuss supplemental information, guidance or instructions, if any, that required deviation from the checklist. Discuss all categories which contain "NA" in the "Complete" columns of this format. Comments regarding the content and format of this form and/or its applicability may also be submitted in the comments section.
"Commitments to be Implemented" page: Identify any commitments that are documented within the study. Specify the nature of the commitment, to whom it was or should be made, when the commitment should be enacted upon, etc.
"Mitigation and Special Issues" page: Identify mitigation measures that are specified within the report, if any. Also, identify any special issues that are addressed within the document that should be considered by the Project Team as it makes decisions regarding the project.
"Signature" page: Signatures of Prime Consultant and KYTC/DEA Environmental Project Manager/Reviewer will attest that the base study meets the requirements set forth in this checklist. Signatures of KYTC Project Manager and District Environmental Coordinator ensure that the findings of the report, including impacts to the project and mitigation measures have been presented to the project development team and are acceptable.
Completed form is to be delivered to KYTC with the document. Previous checklists for the document, or a copy thereof, shall be attached to the current checklist.
| 1 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
| Required | Complete | DEA | CATEGORY |
| Insert check mark as appropriate | Phase I Site Assessment |
||
| X |
Introduction section. |
||
| X | Describe the area geology and hydrogeology at and around the site(s). Perform and describe a historical review of past site(s) and surrounding land uses. | ||
| X | Perform site reconnaissance and describe the sites(s) current use. | ||
| X | Inventory and describe any chemical and/or hazardous materials used on the subject site(s). Discuss any past or present waste disposal practices at the site(s). | ||
| X | Discuss any past or present PCB electrical equipment usage at the site(s). | ||
| X | Discuss any staining and stressed vegetation at the site(s). | ||
| X | Discuss what the water supply is and if there are any wells at the site(s). | ||
| X | Interview local fire and health department representatives to see if there any environmental concerns at the site(s). Review and describe any regulatory listed facilities in the area around the site(s). | ||
| X | Provide conclusions and recommendations for Phase II site Assessment. | ||
| 2 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
| Required | Complete | DEA | CATEGORY |
| Insert check mark as appropriate | Phase II Site Assessment |
||
| X | Discuss the site(s) background information. | ||
| X | Review and discuss technical approaches for assessing the site(s). | ||
| X | Conduct interviews and review site records to gain a better understanding of past and current operational practices. | ||
| X | Prepare phase II site assessment work plan that outlines your selected approach. | ||
| X | Execute the phase II site assessment work plan. | ||
| X | Review phase II site assessment data. Prepare a final phase II site assessment with conclusions and recommendations for corrective action (Phase III). | ||
| Insert check mark as appropriate | Phase III Corrective Action |
||
| X | Discuss the site(s) background information and purpose. | ||
| X | Review all available site(s) records. | ||
| X | Review and discuss technical approaches for remediating the contamination at the site(s). | ||
| X | Prepare a Phase III Corrective Action work plan that outlines your selected approach. Execute the Phase III Corrective Action work plan. | ||
| X | Review and/or monitor the corrective action until completion. | ||
| X | Submit quarterly and/or annual reports summarizing the effectiveness of our selected corrective action. Make modifications as needed. | ||
| 3 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
Discuss supplemental information, guidance or instructions that required deviation from the checklist. Discuss all categories which contain "NA" in the "Complete" columns of this format. Comments regarding the content and format of this form and/or its applicability may also be submitted through this section.
| 4 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
Identify any commitments that are documented within the study. Specify the nature of the commitment, to whom it was or should be made, when the commitment should be enacted upon, etc.
| 5 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
Identify mitigation measures that are specified within the report, if any. Also, identify any special issues that are addressed within the document that should be considered by the Project Team as it makes decisions regarding the project.
| 6 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
I have reviewed the project documentation and attest that those responsible for its preparation are familiar with the requirements set forth in the checklist above and that proper management controls were in effect throughout the course of document development to assure that the document is complete, thorough and addresses all applicable checklist components.
| Prime Consultant | Date |
Recommended for Approval By:
| KYTC/DEA Environmental Project Manager/Reviewer | Date |
Team Review of Commitments
The findings of the report, including impacts to the project and project commitments, have been presented to the Project Team and will be considered during the development of this project.
| KYTC/District Environmental Coordinator | Date |
| Project Manager | Date |
| 7 | |
| Item No: | TC-DEA Form 8 December 1, 2002 |
