NDOT UNEXPECTED WASTE NOTIFICATION FORM (NDOT Form 691)
Project Name	Date
Control Number
Project Discovery Location
Date and Time of Discovery
Contact Person	Phone Number
Unexpected Waste Description
Waste type:
Construction and demolition debris	Municipal (household) waste
Contaminated (petroleum-stained soil)	Other:
Procedures: Were the following procedures following?
1.	Stopped work	Yes	No
2.	Secured site in area of discovery	Yes	No
3.	Notified NDOT Construction Project Manager or Site Inspector of discovery	Yes	No
4.	Filed NDOT Unexpected Waste Notification Form with Environmental Section?	Yes	No
Contamination determination: Were any of the following characteristics identified?
1.	Drums, barrels, or sealed containers of varying sizes	Yes	No
2.	Unknown underground storage tank(s)	Yes	No
3.	Stained or discolored soils	Yes	No
4.	Gasoline odor	Yes	No
5.	Other odor (description)	Yes	No
6.	Oily residue	Yes	No
7.	Sheen on groundwater	Yes	No
8.	Cinders, slag, or other combustion products like ash	Yes	No
9.	Asbestos	Yes	No
If possible contamination was determined, which of the following regulatory agencies were contacted?
Agency notification for drums, barrels, or sealed containers, petroleum-contaminated materials, other contaminated materials:
1.	NDOT - RDCU (402) 479-4766/4312	Yes	No
2a.	DWEE - (402) 471-2186 (during office hours)	Yes	No
2b.	Nebraska State Patrol (402) 471-4545 (after hours)	Yes	No
3.	NDOT-approved Environmental Contractor	Yes	No
Agency notification for unknown underground storage tanks:
1.	NDOT - RDCU (402) 479-4766/4312	Yes	No
2a.	DWEE - (402) 471-2186 (during office hours)	Yes	No
2b.	Nebraska State Patrol (402) 471-4545 (after hours)	Yes	No
3.	State Fire Marshall's Office Flammable Liquid Storage Tank Division (402) 4719467	Yes	No
Documentation of discovery:
1.	Were photographs taken?	Location:	Yes	No
2.	Were environmental samples collected?	Description:	Yes	No

NDOT UNEXPECTED WASTE NOTIFICATION FORM

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NDOT Unexpected Waste Notification Form Sept. 2025	Project Location:
Date: