452d BASE CIVIL ENGINEERING WORK CLEARANCE/DIG REQUEST (See instructions on Reverse. This document can be emailed to each office digitally and signed digitally using multiple copies)

1.

On Work Order No. , Contract No. ______________________________involving excavation or utility disturbance per attached sketch.

2. This area has been delineated in the field according to instructions on the back of the March Form 103.

DATE DELINEATED

3. TYPES OF CONSTRUCTION WORK/BLDG SYSTEMS INVOLVED (Check all that apply)

A .Trenching, Concrete/Pavements, Grading D. Fire Detection/Suppression Systems G. Requires Airfield/Security Access

B. Interior Renovation E. Utilities Overhead Underground H. HVAC

C. Exterior Renovation F. Comm Overhead Underground I. Irrigation

4. REQUESTING OFFICIAL NAME: 5. REQUESTING OFFICIAL SIGNATURE 6. REQUESTING OFFICIAL ORGANIZATION

7. REQUESTING OFFICIAL

TELEPHONE:

8. TELEPHONE NO.

Organization Reviewers Name, Initials, Date

Comments (Expand in Section 22 if required)

10.

B A S E

C I V I L

E N G I N E E R I N G

A. PRIMARY ELECTRICAL DIST.

City Light & Power, Bldg 2408 562-753-4912

B. SECONDARY ELECTRICAL DIST.

BOS Contractor Bldg 2405 951-655-4880

C. POL DISTRIBUTION

BOS Contractor Bldg 2405 951-655-4880

D. GAS DISTRIBUTION

BOS Contractor Bldg 2405 951-655-4880

E. STORM WATER BOS

Contractor Bldg 2405 951-655-4880

F. CATHODIC PROTECTION

BOS Contractor Bldg 2405 951-655-4880

G. FIRE SUPPRESSION LINES

BOS Contractor Bldg 2405 951-655-4880

. IRRIGATION

CEC

Bldg 2403 951-655-5983

11. SECURITY FORCES

Bldg 457 951-655-2981

12. SAFETY

Bldg 394 951-655-4481

13. COMMUNICATIONS/CABLE TV

Bldg 2404 951-655-3000

14. FIRE DEPARTMENT

Bldg 1290 951-655-5001

15. AIRFIELD MGMT (If applicable) Bldg 395 951-655-6000

17. PROJECT (CEC) REPRESENTATIVE

Bldg 2403 951-655-3787

18. REMARKS:

19. REQUESTED CLEARANCE APPROVED DISAPPROVED

20. EXPIRATION DATE:

21. APPROVING OFFICIAL PRINTED NAME/SIGNATURE (BCE/

DBCE/CHIEF CEC)

22. APPROVAL DATE:

MARCH 103, Dated 19 AUG 2024 PREVIOUS EDITIONS ARE OBSOLETE

16.Environmental Flight (CEV) Bldg 2403 951-655-2197

Must attach SW Control Certificate for approval

951-789-5110

9. REQUESTING OFFICIAL EMAIL ADDRESS

22. REMARKS.

MARCH FORM 103, Dated 19 AUG 2024

This section must describe specific precautionary measure to be taken before and during work accomplishment. Specific comments concerning the approved method of excavation, hand or powered equipment, should be included. Recommend, as applicable, attaching site drawings, maps, floor plans, etc. indicating location of construction activity.

Any project that will result in a ground disturbance or placement of materials on ground that can pollute the storm water system must have a Storm Water and Erosion Control Certificate attached with the appropriate erosion and sediment control plan and drawings or Storm Water Pollution Protection Plan in compliance with the March ARB MS4 General Storm Water Permit. BMPs can be described here , but must be shown on the drawings.

1. No excavation or penetration of ground surface may be performed on March Air Reserve Base without an approved March Form 103 Work Clearance Request/Dig Permit. Permits will not be approved for contracted projects without an attached copy of an approved AF form 332 (Not required for maintenance and repair work requiring less than 40 hours of work or a Cost of < $2300) and approved AF form 813 or appropriate NEPA document.

2. Requester shall clearly delineate in the field, the area(s) of work/dig to be marked by utility owners/requesters prior to submission of March ARB Form 103. Mark the area to be excavated with water soluble or chalk based white paint on paved surfaces or with other suitable markings such as flags or stakes on unpaved areas. Delineated areas for a single permit shall not exceed 500 linear feet in any dimension.

3. Requester shall complete blocks 1 through 9 on March ARB Form 103. Requester shall include with this form drawings, photos, Storm Water and Erosion Control Certificate, etc. depicting where work activity will occur.

4. Requester will submit form to Utility owners and/or reviewing organizations who will use locater equipment to mark or clear the delineated area, sign the March ARB Form 103 and return it to Requester within 5 working days of receipt. If utilities are not present within the requester’s delineated area the utility owner shall mark no power, no water, no gas etc. to indicate the utility has visited the site and their respective utility is not present.

5. Marking colors shall be in accordance with American Public Works Association standards as follows:

White:

Red:

Proposed Excavation Electric Power Lines, Cables, Conduit and Lighting Cables

Orange: Communication, Alarm or Signal Lines, Cables

Purple:

Pink:

Reclaimed Water, Irrigation and Slurry Lines Temporary Survey Markings

Yellow:

Blue:

Green:

Gas, Oil, Steam Petroleum or Gaseous Materials Potable Water Sewers and Drain Lines

6. Signatures may be obtained by electronic means and digitally entered. Multiple copies of first page are acceptable to show all signatures. Once all signatures have been obtained on one or more copies of the form, requester shall return/forward via email of all signature pages of the form to the Project (CEC) Representative or directly to the BCE/CHIEF CEC/CHIEF CECC in Bldg 2403, for approval.

7. Approving Official will keep a copy of the approved permit and provide in person or forward via email the original to the requester who shall keep a copy of the approved permit posted at the job site and maintain all markings established by utility owners during excavation.

8. Permits shall be valid as indicated in Block 20. No excavation shall be permitted beyond the expiration date unless a renewal is applied for within 5 working days prior to the date of expiration.

9. Requester shall hand expose to the point of no conflict 24" on either side of the marked underground utility using only non-metallic hand tools in order to precisely locate the utility. If the utility is not uncovered during this process, the excavator shall immediately notify the 452 MSG/CECC Chief for further guidance before continuing excavation.

10. Requester shall immediately halt excavation and notify BOS Contractor at 951-665-4880 if utility damage occurs. If the line is gas or electrical, excavator shall also immediately notify the Fire Department at 951-665-2911. If damage to utilities is due to contractor non-compliance with permit instructions or contract requirements, repairs will be at Requester’s expense. If unmarked utilities are uncovered/damaged requester must immediately stop work in the area and contact the CE project representative for instruction.

11. Any project that will result in a ground disturbance or placement of materials on ground that can pollute the storm water system must have a Storm Water Control Certificate attached with the appropriate erosion and sediment control plan and drawings or Storm Water Pollution Protection Plan in compliance with the March ARB MS4 General Storm Water Permit. Digging may not begin on any disturbance greater than 1 acre without an approved Construction Permit from Riverside County.

(REVERSE)

INSTRUCTIONS

The BCE Work Clearance/Dig request is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic flow, base utility services, protection provided by fire and intrusion alarm system, or routine activities of the installation. This form is used to coordinate the required work with key base activities and keep customer inconvenience to a minimum. It is also used to identify potentially hazardous work conditions in an attempt to prevent accidents. The work clearance request is processed 1-14 DAYS prior to the start of work. If delays are encountered and the conditions at the job site change (or may have changed) this work clearance request must be reprocessed.