HAZARDOUS SUBSTANCES, CONTAMINATION and	Wisconsin Department of Transportation

ASBESTOS EVALUATION

Factor Sheet D-4

Alternative	Preferred Yes No None Identified	Project ID:

1.	Briefly describe the results of the Phase 1 Hazardous Materials Assessment for this alternative. Do not use property identifiers including owner name, address or business name. Attach additional sheets if necessary.

Site Reference #	Land Use of Concern (Past or Present)	Contaminants of Concern	Phase 1 Recommendations (No further action, or is a phase 2, 2.5 or 3 recommended for this site, and why?)

Additional comments:

2.	Were any parcels not included in the Phase 1 assessment?

No

Yes – How many:

Why were the parcels not reviewed?

3. Are there any sites with continuing obligations or deed restrictions?

No

Yes – Complete the table for each site closed with continuing obligations or deed restrictions.

Site Reference #	Soil or Excavation Restrictions	Groundwater Restrictions	Cover Restrictions	Other Restrictions	DNR Notification Required?
No Yes Yes, DNR has been notified. DNR response is attached.
No Yes Yes, DNR has been notified. DNR response is attached.
No Yes Yes, DNR has been notified. DNR response is attached.

4. Have Phase 2, 2.5 or 3 Assessments been completed? Discuss the results.

Site Reference #	Phase 2, 2.5 or 3 Recommendations	Materials Handling Plan or Remediation Recommended?	Is WisDOT a Responsible Party?
Yes	No	Yes	No

Describe the results of any additional investigations performed by WisDOT or others (Include the number of sites investigated, the level of investigation and results for each site that relates to this project).

6. Describe any design elements that have been incorporate into this alternative to avoid any contaminated sites.

Describe the remediation and waste management practices to be included in the design for areas where contamination cannot be avoided (e.g., materials handling plan, remediation of contamination, design changes to minimize disturbances).

List any parcels with known contamination which are proposed for acquisition.

ASBESTOS

Have the bridges been inspected for the presence of asbestos containing material (ACM)?

No – Explain:

Yes – Fill out the table. Insert additional rows as needed.

Bridge Number	Results of Asbestos Sampling	Proposed Work (brief description)	List the Appropriate Special Provision

Note: All structures to be acquired and demolished or relocated require asbestos inspections and will be

inspected once acquisition has taken place.