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REPAIR OR ALTERATION OF UNDERGROUND UTILITIES OWNER: WEATHER: DATE: PROJECT NO.: PROJECT NAME: CONTRACTOR: DISTURBANCE OF UTILITY REPAIR OF UTILITY Utility No. Date Repaired Repairs Performed by Length of Repair Section Materials Used Remarks 1 2 3 4 5 6 7 REPORT BY: Utility No. Type of Utility Disturbed Location Date Exposed How Damaged Condition When Exposed Station Address / Street 1 2 3 4 5 6 7