T.B. PAGE:_________________________________________ DATE:__________________ESTIMATED START DATE________________________
DISTRICT:_____________________________________________________CITY:_________________________________________________________
#OF M.H.'S:_________________AVERAGE DEPTH:__________________PIPE SIZE:_____________
M.H. TYPE (I.E.S.-17 OR S-2)_______________REG. OR T-LOCK_________________LEAVE M.H.'S 6"-9" LOW: YES OR NO
LOCKING RINGS & COVERS: YES OR NO if yes how many___________
#OF M.H.'S:_________________AVERAGE DEPTH:__________________PIPE SIZE:_____________
M.H. TYPE (I.E.S.-17 OR S-2)_______________REG. OR T-LOCK_________________LEAVE M.H.'S 6"-9" LOW: YES OR NO
LOCKING RINGS & COVERS: YES OR NO if yes how many___________
GROUND WATER YES OR NO /// ANY WRAP-UP INSURANCE: YES OR NO
PREVAILING WAGE JOB: YES OR NO /// BUY AMERICA PROJECT (USA): YES OR NO
ANYTHING SPECIAL THAT MAY BE REQUIRED, THAT IS NOT ON THIS FORM PLEASE LIST BELOW
_______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
IF REQUIRED SHOULD WE INCLUDE THE FOLLOWING
T-LOCK WELDING: YES OR NO VACUUM TESTING: YES OR NO
SAN-CON 100 POLYURETHANE INTERIOR COATING: YES OR NO
EXTERIOR COATINGS ARE EXCLUDED
NIGHT WORK WILL BE EXCLUDED UNLESS OTHERWISE STATED ABOVE.
CONTRACTOR'S NAME:______________________________________________________________________________________________________
CONTRACTOR'S PH. #_______________________FAX #_____________________ESTIMATORS NAME:__________________________________
DATE OF REQUEST:_____________________CONTRACTOR'S EMAIL ADDRESS:___________________________________________________
ENTIRE FORM MUST BE FILLED OUT AND RETURNED, BEFORE PROJECT IS QUOTED.
