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Appendix IV. Field data sheets, codes, etc.

S u r v e y o r ( s ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date

______________

Page_____ of

______

Shoreline Survey ID

Town

Tax Map

Lot Number

Area Name

OBD #

Owner Last Name

Owner First Name

Street Address

Pollution Type/Code

Problem: Y or N Year Round or Seasonal

Pollution Distance to

PS Latitude:

water:

Ft.

°'

"N

PS Longitude: °'

"W

Pollution Source: Actual or Potential

Pollution Path: Direct or

Indirect

Pollution Source Description:

Property Description:

Shoreline Survey ID

Owner Last Name

Town

Tax Map

Owner First Name

Street Address

Lot Number

Area Name

OBD #

Pollution Type/Code

Problem: Y or N Year Round or Seasonal

Pollution Distance to

PS Latitude:

water:

Ft.

°'

"N

PS Longitude: °'

"W

Pollution Source: Actual or Potential

Pollution Path: Direct or

Indirect

Pollution Source Description:

Property Description:

Shoreline Survey ID

Owner Last Name

Town

Tax Map

Owner First Name

Street Address

Lot Number

Area Name

OBD #

Pollution Type/Code

Problem: Y or N Year Round or Seasonal

Pollution Distance to

PS Latitude:

water:

Ft.

°'

"N

PS Longitude: °'

"W

Pollution Source: Actual or Potential

Pollution Path: Direct or

Indirect

Pollution Source Description:

Property Description:

Shoreline Survey ID

Owner Last Name

Town

Tax Map

Owner First Name

Street Address

Lot Number

Area Name

OBD #

Pollution Type/Code

Problem: Y or N Year Round or Seasonal

Pollution Distance to

PS Latitude:

water:

Ft.

°'

"N

PS Longitude: °'

"W

Pollution Source: Actual or Potential

Pollution Path: Direct or

Indirect

Pollution Source Description:

Property Description:

63

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