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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


Yes
No


Yes
No


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?
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