Please complete as much of the following as possible, though its OK to leave one or more questions blank. Advice for completing this form is provided at: Please complete a separate form each time you visit a site.

* 1. Construction Site Information: Please provide as much of the following information as you can.

* 2. When did you evaluate the site?


* 3. LOCATION: Since most sites lack a street address could you describe the location (e.g., on the north side of Main Street 1/4 mile east of First Avenue):

* 4. Could we get your contact information in case we have questions and so we can provide you with an update on what your report and that of others has accomplished? At a minimum, please provide your name and email address. The next question allows you to remain anonymous, if you wish.

* 5. Would you like us to treat this report as anonymous?

* 6. What percentage of the site is:

The answers to Question 6 must total 100%.

* 7. Are bulldozers, graders or other earth-moving equipment present on the site?

* 8. Do you see vegetation growing throughout the site indicating that earth-moving has ceased for some time and stabilization should have been completed?

* 9. What portion of the site is at rough grade as indicated by the presence of buildings, building foundations, road or parking lot beds?

* 10. Is there anything else you think we should know?