Pothole Form SCHEDULE A SERVICE ONLINE Select the Service You NeedUtility LocatingGPR ScanningMappingConcrete ScanningPotholingCCTV Pipe Inspection Δ Call Now! 1 (866) 638-1075 Company Utility Potholing / Exposing Utilities Via Vacuum Excavation Company Name: * Accounting Email: Company Telephone Number: * Project Name: * Project Address: * Name of Person or Company Representative Requesting Quote: * Direct Number: * Company Representive's Email * Job type: Public Works / Prevailing Wage Private Work Facility type: Job site location: Public Right of Way Private Property Delineation needed? Yes No Call-in USA dig alert ticket? Client Util-Locate Other: Other Potholing Number of potholes needed: (Standard pothole dimension = 12" x 12") Depth (ft) 0'-5' 5'-10' 10'+ Pothole coring required: Yes No Pothole diameter: Standard Pothole Diameter = 8"-10" Special Pothole Diameter Required? Special Pothole Diameter Trenching Number of Trenches Needed: Depth/s: Quantity: Trench size/s (dimensions): High pressure oil or gas lines to be exposed? Yes No Surface Type Surface type: Asphalt Concrete Dirt/Soil/Grass Sand Clay Other: Other Dumping: OK to dump on Site Haul Spoils Away / Dump Offsite City Permits Encroachment permits: Client Will Provide Util-Locate to Provide Not Needed Other: Other Traffic Control Traffic control: Client will provide Util-Locate to provide Not needed Other: Other TC plans: Client will provide Util-Locate to provide Not needed Other: Other Surface Restoration Restoration per city required specs: Yes No Not needed Other: Other Cold temp patch: Yes No Not patch Other: Other Pothole restoration: Client will provide Util-Locate to provide Not needed Other: Other Special Notes Write notes below:
