Utility Locate Request Utility Locate Request (Old) Requestor's Information FORM NUMBER (Automatically Generated) TIME STAMP (Automatically Generated) Requestors Name * Phone Number * Email * Work Order or Project Number * University Project Manager / Coordinator * Exavating Contractor * Phone Number * Excavation Information Today's Date * Proposed Excavation Date * Anticipated Backfill Date * Will excavation occur on the weekend or a University closure day? If yes, is there a plan in case of an emergency? Will the excavation be completed within the 15-business day timeframe? * Yes No Is the excavation site within a fenced area? * Yes No Is this a trench, hole, or both? * Trench Hole Both Trench Indicate approximate dimensions. If not applicable, please use 0. Width * Depth * Linear Feet * Hole Indicate approximate dimensions. If not applicable, please use 0. Diameter * Depth * Quantity * Will the site require new utility/as-built verification or testing prior to backfill? * Yes No If yes, indicate anticipated backfill date: Submit Map and or Drawings * Drop a file here or click to upload Choose File Maximum upload size: 56.32MB Please attach a map of the area which needs to be surveryed Brief description of work or other useful information: A 48-Hour Notice is Required with Blue Stakes Utah Have You Notified Blue Stakes of Utah? * Yes No What is the reference number? Important In the event of a utility disruption, immediately call University Dispatch at (801) 581-7221. Be on the lookout for unknown utility lines and follow all excavation protocols as outline in the Blue Stakes’ of Utah Excavator’s Guide. The contractor is liable for all damages incurred during excavation. The sole purpose of this document is to request line information for The University of Utah campus and properties. This document does not grant the right to excavate. Be sure to comply with all Building Permits as outlined by the Building Code Official. Any requests beyond this scope will be denied. In the event utilities are located and or damaged, the contractor shall contact Lenard Barney (801) 718-0804 or Matt Stones (801) 608-6680. Utility Map Provided By: Clear Please sign Date Utility Marking Provided By: Clear Please sign Date Submit If you are human, leave this field blank.