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Subsurface Utility Clearance <br /> Management Program 2.9 <br /> Appendix B - Example of Completed One Call Report <br /> Example Completed One-Call Report <br /> New York 811 <br /> Send To: C_EMAIL Seq No: 744 <br /> Ticket No: 133451007 ROUTINE <br /> Start Date: 12/16/13 Time: 7:00 AM Lead Time: 20 <br /> State: NY County: QUEENS Place: QUEENS <br /> Dig Street: 46TH AVE Address: <br /> Nearest Intersecting Street: VERNON BLVD <br /> Second Intersecting Street: 11TH ST <br /> Type of Work: SOIL BORINGS <br /> Type of Equipment: GEOPROBE <br /> Work Being Done For: ROUX <br /> In Street: X On Sidewalk: X Private Property: Other: <br /> On Property Location if Private: Front: Rear: Side: <br /> Location of Work: MARK THE ENTIRE NORTH SIDE OF THE STREET AND SIDEWALK OF: <br /> 46TH AVE BETWEEN VERNON BLVD AND 11TH STREET <br /> Remarks: <br /> Nad: Lat: Lon: Zone: <br /> ExCoord NW Lat: 40.7475399 Lon: -73.9534811 SE Lat: 40.7457406 Lon: -73.9493680 <br /> Company ZEBRA ENVIROMENTAL Best Time: 6AM-5PM <br /> Contact Name: DAVID VINES Phone: (516)596-6300 <br /> Field Contact: DAVID VINES Phone: (516)596-6300 <br /> Caller Address: 30 N PROSPECT AVE Fax Phone: (516)596-4422 <br /> LYNBROOK, NY 11563 <br /> Email Address: davidCa)zebraenv.com <br /> Additional Operators Notified: <br /> ATTNY01 AT&T CORPORATION (903)753-3145 <br /> CEQ CONSOLIDATED EDISON CO. OF N.Y (800)778-9140 <br /> MCINY01 MCI (800)289-3427 <br /> PANYNJ01 PORT AUTHORITY OF NY& NJ (201)595-4841 <br /> VZQ VERIZON COMMUNICATIONS (516)297-1602 <br /> Link to Map for C_EMAIL: http://ny.itic.occinc.com/XGMZ-DF2-L23-YAY <br /> Original Call Date: 12/11/13 Time: 1:15 PM Op: webusr <br /> IMPORTANT NOTE: YOU MUST CONTACT ANY OTHER UTILITIES DIRECTLY <br /> 1/2019 Corporate Health and Safety Management Program ROUX 1 <br />