Page 11 - West Virgina 2017 Issue 2

the damage may be only a dhlnnt memory. The party wnh me bc~'ldocumcnt.1l|un wm mow‘! always havc thc adv.1nlagc.Bc
mnhml and pmsnnt me ram. You do not nmd m be edneemed wnh Ilsmg pmpcr legal terms to dmcnbc what your mvL‘~ug.1l|on
discovered Just record me faCl~ 1n the but way you can and you will always be ablc to cunfidcntly dcfcnd your report.
A pmpu InvL‘~ug.1tmn [ullownd by Clea: and ednme documentation 1. the key to e.mbI..hmg cmd|b|l|ty wxlh all mvolvcd.
Remember m my fucuscd on findm (he came of the damn e. when vm. do, Khcl|abIlItv1~sIIcs mu lake can: of lhL‘m,~.clvL‘~.
, £4 5 , , 8
# D mlgflle Damage Address/Locauon
mm T Vzmmvv T
. Named by
llanagem.-stlgaumllenalt M M
Date and time of damage m known}
1. Damaged utility information D0 notmmD\e(evepun>IIa:\hzy1:
U Aevm D N01 flamaged E] maze [1 Non Huluvev Cl Nul d.m.ged by !xL.1v4|\un
|:| Commumcauons/CATV
2 Who]: domg me work?
III came ( D Fwber |j (upper) [°'“'“”"
|:|Dvop/semce 5Ub*(°Wad°r-
\fi|ub<n\vw2<n>mdangcanuazmvm<h.denm\e
Size/Mal T
3 Lrxate vequest infmmation
[:1 Gas A. lsthere a valid Vocate request?
5' Yesrlwzkenfi
g No Mm) thetkane}
El Mam D No Vacate request
|j semee D '"W‘‘*’ “(W T
5 mm the edmpany domgme wdmeduesxmeueken Dyes D nu
Size/Mal
D Em“ c wmark: are presentavexheyfurlhws wdeaxe yequesuexmauom Eyes [3 run
4 On site facts lasuldate nhrvvextvgatmn)
III Pvimary A I I f d7
Dsemndaw/SEW“ . sctansany ocatovo vecor
S|ze/Ma( 9‘
D No mndenemne)
gmmed back to may (mnflvmalmn -n T
[:1 Watev/Sewer Um"
3 Avetheve mavksfordamagediazwlm/7 Eve; (um. um.) EINU lgoxnxemauay
c Cundmon dvmam D Hwgmyvlswble D vmexe D Faded
D Mm" D Are mzvks w\(hm1B' at me 1a:\|\ty7
|:| sennce D ye}
Size/Mal El Excavamrmd not use approved memeu ua expose plan!
D Damaged (Kurds one) expdsed want exposing plam
N
Utility Represemauvecaman D ° C, Mavked of, mwmmgmg
D unldeaxame plant
Name T I] Lomlmg pmceduves/techniques
Phone T D Nnton site