Utility Locate Form

Facilities Services - Tarleton State University

THIS FORM MUST BE TURNED IN AT LEAST 72 HOURS PRIOR TO DIGGING. DIGGING IS NOT PERMITTED UNTIL THIS FORM HAS BEEN COMPLETED AND RETURNED TO THE PROJECT MANAGER. Contractor shall verify the exact location of underground utilities. All utilities that are not owned by Tarleton shall require the utility's owner to field verify their location before excavation. The contractor is responsible for any and all damage to existing utilities and the contractor shall repair all damaged utilities to their original condition at no cost to the owner.

1Investigator Ifnormation > 2Personal Safety > 3Hazardous Watse
Date Date / MM / DD YYYY
IS THIS DIG AN EMERGENCY?

IS THIS DIG AN EMERGENCY? YES NO
REQUESTER NAME REQUESTER NAME First Last
REQUESTER E-MAIL
PHONE NUMBER PHONE NUMBER - ### - ### ####
PROJECT NAME
WORK ORDER NUMBER
PROJECT NUMBER/DESCRIPTION
CONTRACTOR
DEPTH OF EXCAVATION
BUILDING/PARKING LOT #
HAS THE AREA BEEN PRE-MARKED?

HAS THE AREA BEEN PRE-MARKED? YES NO
APPROXIMATE START DATE APPROXIMATE START DATE / MM / DD YYYY
WAS 811 NOTIFIED?

WAS 811 NOTIFIED? YES NO
IF YES, PROVIDE TICKET NUMBER