Exposed Soil = Pollution Aerial Photo Assessment Database

Please complete as much of the following as possible, though its OK to leave one or more questions blank.

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

Name of Construction Site:

City/Town:

County:

State:

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* 2. Aerial photo date:

Date:

Date

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* 3. Site coordinates:

Latitude:

Longitude:

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* 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.

Name:

Email Address: *

Phone Number:

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

Yes

Doesn't Matter

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* 6. Do you see indications on the aerial photo that road, parking lot or building construction has begun? If no or uncertain check the site again when more recent aerial photos become available and go on to another site.

Yes

Uncertain

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* 7. What percentage of the construction site is:

Covered with grass:

Covered with straw mulch:

Covered with stone:

Exposed soil:

Rooftops, paved roads, parking lots or other surfaces:

Other:

The answers to Question 7 must total 100%.

Question Title

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

Question Title

* 2. Aerial photo date:

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* 3. Site coordinates:

Question Title

* 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.

Question Title

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

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* 6. Do you see indications on the aerial photo that road, parking lot or building construction has begun? If no or uncertain check the site again when more recent aerial photos become available and go on to another site.

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* 7. What percentage of the construction site is:

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