Line Damage

SEWER LINE DAMAGE REPORT

UPSTREAM MH #:

DOWNSTREAM MH #:

DISTANCE FROM UPSTREAM MANHOLE:

DATE:

COMMENTS:

DAMAGE RATING:

INSPECTOR: —Please choose an option—JIM L.TOM N.JASON S.DALE M.DAN N.WES S.NATE H.ANDY W.STEVE A.MARK W.DAN D.JAMIE R.

INSPECTOR: —Please choose an option—JIM L.TOM N.JASON S.DALE M.DAN N.WES S.NATE H.ANDY W.STEVE A.MARK W.DAN D.JAMIE R.

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