Attch-4 Utility Locate Request Form.pdf

This is a Utility Locate Request Form used by the Directorate of Public Works (DPW) at Fort Leavenworth, Kansas. The form is submitted by customers requesting utility location and marking services prior to excavation or ground-disturbing work on the installation. All requests must be submitted seven business days in advance, and remarks requiring utility re-marking require seven business days advance notice. A specific date for utility location cannot be requested earlier than seven business days from the date the request is submitted.

The form requires customers to provide detailed project information including point of contact name and phone number, company name, work type, explosives use, trenchless excavation method, project duration, work address, nearest intersecting street, and driving directions with marking instructions. Customers are responsible for independently contacting Kansas One Call at 1-800-344-7233 for primary utility checks and must provide the resulting Kansas One ticket number. The DPW processes requests to locate and mark gas, electric, phone/coax/fiber, environmental, geothermal, water, and other utilities. Upon project completion, all utility flags must be removed from the work area. The DPW section of the form documents receipt, notified utilities, ticket numbers for various utilities, and completion notification to the requesting point of contact.