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0 10 <br /> Utilities Contacted by Utility Contact Utility Contacted Marked In <br /> 811 Number by Telephone Field Other(Describe) <br /> Contact information verified by(K/1 Staff): <br /> Scheduled On-Site Meeting Location(If applicable): <br /> Public Utility <br /> Private Utility Locator <br /> Use back of sheet to sketch of identified utilities and proposed boring/excavation locations OR attach figure. <br /> Include north arrow and structures If applicable. <br /> Notes: <br /> • Mark all proposed borings and excavations with WHITE paint per APWA Utility Color Codes. <br /> • Request locator to mark utilities as required by their standard operating procedures or at least within 25 feet <br /> of boring/excavation,whichever is greater,with paint/flags. <br /> • Utility marks are valid for 14 calendar days and must be remarked if work continues beyond 14 days. <br /> 02010 Kennedy/Jenks Consultants <br /> BNSF Bend OR <br /> Utility Notificabon Form December 2015 <br /> nppy zjjsdoyWahFpMb =11010 h.p%W�sl_ImtobwXN Ad <br />