**[SURVEY PLAN]{.underline} Page 1 of 8 Date:
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This form is provided to the user/sponsor for assistance in determining
the vessel requirements for the project. Close attention to detail is
essential to the success of the project. So please, please complete the
form as accurately as possible. Draw a single line through any item that
does not apply. Do not include any information which is or may be deemed
classified. Additional information may be provided on the last page.

**1.0 GENERAL**

Project Title: Survey Title: GUARDIAN Requested by: Organization:

Project/Work Assignment Manager: Organization: Survey Chief Scientist:
Organization: Organization Address: Phone No.: Fax No.: EPA
Grant/Contact: Work Assignment No.:

Principal Investigator: Organization: P.I. Telephone No.: FAX No.:

Comments:

**2.0 SCHEDULE OF OPERATIONS**

**FUNCTION DATE TIME LOCATION FUNCTION DATE TIME LOCATION**

Commence Mobilization Complete Mobilization

Pre-sail Conference Dock Trials

Depart Home Base Arrive on Station

Depart Station Arrive Home Base

Start Demobilization Finish Demobilization Post-sail Conference

Allowable Weather/Breakdown Days Maximum Duration (Days)

Comments:

**3.0 CHEMICAL BACKGROUND INFORMATION** (Including standards, spikes,
and instrument calibration chemicals). ***NOTICE:** A MATERIAL SAFETY
DATA SHEET (MSDS) MUST ACCOMPANY EVERY CHEMICAL OR REAGENT THAT IS
BROUGHT ABOARD THE LAKE GUARDIAN. COMPLIANCE WITH THIS REQUEST IS
ABSOLUTELY NECESSARY PRIOR TO THE SHIP\'S DEPARTURE. ADDITIONALLY,
CHEMICAL WASTES GENERATED BY SHIP\'S USERS MUST BE REMOVED BY USERS. THE
USER IS RESPONSIBLE FOR PROVIDING PROVISIONS FOR PROPER WASTE STORAGE
METHODS/CONTAINERS* **CHEMICAL NAME QUANTITY CONCENTRATION**

**[SURVEY PLAN]{.underline} Page 2 of 8 Date:**

**4.0 SURVEY JUSTIFICATION AND RATIONALE**

**5.0 OBJECTIVES**

Project:

Survey:

**6.0 ENVIRONMENTAL MANAGEMENT QUESTIONS ASKED BY PROJECT/SURVEY**

**7.0 SURVEY LOCATION AND DESCRIPTION** (Attach Detail/Figures If
Needed)

Survey Area(s) Name(s) or Geographic

Name:

Survey Area Locations (Provide Map):

Survey Area Boundary Coordinates (Lat/Long):

Survey Station Types (Water/Sediment):

Number of Stations By Type:

Water Depth Required: Sediment Zone Required:

Survey Transect Lengths: Transect Line Spacings:

Other:

**[SURVEY PLAN]{.underline} Page 3 of 8 Date:
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**8.0 SURVEY/SAMPLING METHODOLOGIES** (Attach Detail/Tables/Figures If
Needed)

Method Descriptions:

Method Rationale:

Diving On Survey: YES: NO: (If yes, see Section 15 and 16)

**9.0 SEQUENCE OF SURVEY TASKS/EVENTS**

**10.0 SURVEY COMMUNICATIONS REQUIREMENTS**

1\. HF FREQ

2\. VHF FREQ

3\. UHF FREQ

4\. LORAN-C 5. RADAR

6\. GYROCOMPASS 7. SATNAV

8\. OMEGA 9. DECCA

10\. OTHER COMMUNICATION 11. OTHER NAVIGATION

**[SURVEY PLAN]{.underline} Page 4 of 8 Date:
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**11.0 SHIPBOARD SERVICES EQUIPMENT SUPPLIES**

1\. HANDLING EQUIPMENT

PROJECT SUPPLIED GUARDIAN SUPPLIED (Attach GUARDIAN Check List If
Appropriate): 2. LABORATORIES REQUIRED

PROJECT SUPPLIED GUARDIAN SUPPLIED (Attach GUARDIAN Check List If
Appropriate):

3\. DIRECT DECK ACCESS 4.WINCH REQUIREMENTS

PROJECT SUPPLIED GUARDIAN SUPPLIED (Attach GUARDIAN Check List If
Appropriate):

5\. LIFTING GEAR

PROJECT SUPPLIED GUARDIAN SUPPLIED (Attach GUARDIAN Check List If
Appropriate):

6\. OTHER DECK EQUIPMENT:

7\. ELECTRICAL POWER REQUIREMENTS

Description and Location:

8\. WATER REQUIREMENTS

**Fresh Quality Distilled Quantity**

9\. HYDRAULICS

**Pressure Volume**

10\. AIR

**Pressure Volume**

11\. SMALL CRAFT

PROJECT SUPPLIED GUARDIAN SUPPLIED (Attach GUARDIAN Check List If
Appropriate):

IF PROJECT SUPPLIED, PROVIDE

Size Weight O.B. Motor

Purpose

Will the Guardian need to carry the small craft? **YES NO**

**[SURVEY PLAN]{.underline} Page 5 of 8 Date:
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**11.0 SHIPBOARD SERVICES EQUIPMENT SUPPLIES (Continued)**

12\. CREW ASSISTANCE - The crew of the Lake Guardian includes a Science
Officer and Marine Technician who are responsible for operating the
ship\'s science, sampling and laboratory equipment to facilitate your
survey goals. There are also several professional seamen on board to
handle the deck gear (cranes, winches, A-frames, davits, etc\...) for
your use. Beyond this scope however, it is requested that your
scientific party include the appropriate number of personnel to complete
the remainder of your project requirements.

**Rating (Type)** **Number of Personnel**

**Rating (Type)** **Number of Personnel**

**Rating (Type)** **Number of Personnel**

13\. OTHER SHIP REQUIREMENTS:

1\.

2\.

14\. SHORE SUPPORT MOBILIZATION FORCE:

**Welders** **Riggers**

**Mechanics** **Machinists**

**Laborers**

**12.0 OPERATING**

**Sea State:** Wave Height MAX MIN

**Atmospheric Conditions:**

Wind Speed MAX MIN Direction

Temperature MAX MIN

Cloud Cover ANY O\'CAST SUN

Precipitation Permitted Not Permitted

Visibility MAX MIN

Time of Day ANY DAYLIGHT NIGHT

**13.0 SCIENTIFIC PARTY**

1\. Point of Contact

2\. Number of Personnel Maximum Number of Persons to a Cabin

**NAME SURVEY ORGANIZATION TIME/PLACE OF**

**RESPONSIBILITY ARRIVAL AND DEPARTURE**

1\)

2\)

3\)

4\)

5\)

6\)

7\)

8\)

9\)

10\)

**[SURVEY PLAN]{.underline}** **Page 6 of 8** **Date:
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Please indicate below if any persons in your science party have taken
any courses or obtained training and/or certification in:

A. Laboratory Health & Safety B. Field Health & Safety

C. Hazardous Materials Handling D. Emergency Spill Response

E. Respiratory Protection F. Radiation Safety

G. First Aid and/or CPR H. Fire Fighting

I. Small Boat Handling J. Lockout/Tagout

K. Crane/Derrick Operation L. Bloodborne Pathogens

**NAME TRAINING, COURSE OR CERTIFICATION OBTAINED OBTAINED WHEN**

1\)

2\)

3\)

4\)

5\)

6\)

7\)

8\)

9\)

10\)

**COMMENTS:**

**[14.0 PROPOSED REPORTING REQUIREMENTS]{.underline}**

12\. CREW ASSISTANCE

Debriefing Telephone Call: **YES** **NO** **No. Of Days After Demob.:**

Survey Report Due Date (20 Days After Demob.):

Final Report/Other Document Description:

Other Comments:

**15.0 DIVING OPERATIONS**

Locations:

Potential Hazards:

Depth Range: Maximum Depth:

**[SURVEY PLAN]{.underline} Page 7 of 8 Date:
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Dive Master: Organization:

Dive #2: Organization:

Dive #3: Organization:

Dive #4: Organization:

Dive #5: Organization:

Dive #6: Organization:

Dive #7: Organization:

Dive #8: Organization:

Dives\' Tasks:

**REQUIREMENTS REMINDER:**

**OXYGEN WILL BE ON SITE ON BOTH THE GUARDIAN AND TENDER BOAT.**

(Oxygen Will Be Provided By The GUARDIAN.)

**STANDBY DIVER WILL BE SUITED UP IN THE TENDER BOAT READY TO DIVE.**

(Dive Team Scheduling And Bottom Time Planning Must Allow For This.)

GUARDIAN Anchored: **YES: NO:** Tender Boat Anchored: **YES: NO:**

Communications:

Tender Boat:

Special Equipment Needed:

Other:

**[SURVEY PLAN]{.underline} Page 8 of 8 Date:
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**16.0 DIVER EMERGENCY AID LIST**

**DIVERS ALERT NETWORK (DAN) 24-Hour Telephone No.: (919) 684-8111**

**NEAREST DECOMPRESSION CHAMBER** (Facility Name And Address):

Telephone No.: 24-Hour Telephone No.:

Telephone Call On Day Of Initial Diving Operations To Be Made By:

Hyperbaric Physician(s): Telephone No.:

**NEAREST HOSPITAL** (Facility Name And Address):

Telephone No.: 24-Hour Telephone No.:

Hyperbaric Physician(s): Telephone No.:

**NEAREST COAST GUARD STATION** (Facility Name And Address):

VHF Channel: Telephone No.:

**FIRST AID EQUIPMENT:**

Location:

Oxygen Location:

**DIVER MEDIC** (Name If Planned):

**SPECIAL CONSIDERATIONS:**