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Contact Name		Phone		Fax Number
Company
Email
Project Name		Public	Private
Project Location		Engineer		Engineer Phone
Bid Date		Owner

Length	Casing Size	Thickness	Crossing Under	Carrier Size/Material	Application	Is Grade Critical?	Pit Depth
					Gravity Sewer Water Line Force Main	Yes No
					Gravity Sewer Water Line Force Main	Yes No
					Gravity Sewer Water Line Force Main	Yes No

When will job take place?
Who excavates pits?	Midwest Mole	Contractor
Will trench boxes be required?	Yes	No
Who is to Thread and Block the Carrier?	Midwest Mole	Contractor
NOTE: Contractor to furnish casing spacers if required
Is the void inside casing to be grouted?	Yes	No	Don't Know
What are the soil conditions?	Water	Rock	Clay	Sand	Mixed	Gravel
Is the Water Table	Above	Below	the pipe?
Are Boring Logs available?	Yes	No
Comments
Is the site for the pit open or is it tight?
What kind of vehicle access is there?
Are there any utilities that may be a problem?
Are there any lines overhead? (Crane operation)
How critical is line and grade?
Do we need to hit an existing manhole or line?
Other Comments
Authorization Code
Enter Above Code