Date Base Verification
800-344- 7233
(DIG. SAFE)
687-2470
LOCAL WICHITA
(316) 687-3753
FAX
DATABASE VERIFICATION FORM
Please fill in all information after verification of database(s)
has been established.
Terminal Code(s):
S A L I IV /4 L' I
( r)
Yes, I have reviewed the following database(s) and
found all information to be correct.
() No, after verification of the fOllowing database(s), I
have enclosed the following changes.
Date: 22. eel 93
~. .7 I' \ .
Name: ft._<~t).. VII'tIl"(IjI,J
(print)
Signature: ;;{, ~M.4 / A/:/;;::;Z:?/
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NOTE:
Please be aware that you will not be receiving Locate
Requests until this form has been completed and
returned to Kansas One-Call System, Inc.
It is not necessary to return the computer print out.
This is for your records.
8100 E. 22ND ST., BLDG. 2100-1 WICHITA, KS 67226 316-687-2102
KANSAS ONE-CALL RECEIVING STATION INFORMATION
Terminal Code:
SilL IIVA~/
Date: ;J.. L 6" t 17-:5
t- ,/ -.I~f /i ~4 (;:'01 ll~ c, ,,__ LJ I 07)
ellur /{'""/,5C'il JI,,1 d-!,j(t [>",/1'1 It,; ~
, ~
C/t I C/
I
Contact Name or Names:
~j..jl, ~ r
T'-4...L.~1 Address:
Company Name:
~/7
E' c...~1
4J I....
Telephone Number:
9/3 - :1 /.. C: - 7s 8' L'
Alternate Nnmher:
;lIt-,LL
Emergency Number(s):
Hours:
Open:
),'Cc d ~
Close:
,. 'I} (\ ./ lA-<..
I
Type of Underground Facility:
/"/.:,: II t~ ((n~! ~l
"
WI".,'tL..r
After Hours' Telephone Numbers:**
(2 numbers only)
1)
2)
Contact Name:
Phone Number:
Contact Name:
Phone Number:
tU),( CullaL..:c..
f; J - ~; 1 - :/ 7' L
M,_r t__tt:.</
9',.1 .- 8'2,7 -5'7 ()J
**These numbers will only be used outside of Kansas One-CalI's
regular business hours (7:30am to 5pm, Monday-Friday).
RECEIVING EQUIPMENT INFORMATION
Manual (Voice-out) [
]
Printer [
]
Fax [
]
Model of Printer or Fax:
Printer or Fax Phone Number:
Transmission Speed (baud):
NOTE:
Only those members who plan
Locate Requests a month can
Program. All other members
printe):'. . /;)
. // I jl ~ ,/ // /
By .~-7A-. 4, I . '--1. C ....Cr'
, /
on receiving less than 25
utilize the Manual or Fax
must receive from a
Completed
Phone Number: t,<? - 5'2.1. . /.-5)-0
(.
800-3-1-1- 7233
(DIG-S^rE)
687-2470
lDC^l WIClflTA
(316) 687-3753
FAX
SPECIAL SEC'rIOH AND INDIAN RESERVATION SELECT SHEET
Company Name: C;;;:- ~,j., t -:"
[I".... I' (" "-'-"1"-".)/ ~. '-o..'1~
'fermina 1 Code (s) :.5A L I t1i A (I
Date:
~ 2- OC/YJ
Geary County "Special Sections:"
(
Yes, the above-mentioned terminal has underground facilities
in the "special section" areas in Geary County. Please
transmit locate requests for this region.
(~)
No, the above-mentioned terminal does not have underground
facilities in the "special section" areas in Geary County
Therefore, we do not need to receive any locate requests for
this region.
Fort Leavenwortti "Special Sections:"
(
)
Yes, the above-mentioned terminal has underground facilities in
Fort Leavenworth. Please transmit locate requests for this
region.
( J-)
No, the above-mentioned terminal does not have underground
facilities in Fort Leavenworth. Therefore, we do not need to
receive any locate requests for this region.
11
8tOO E. 22ND ST., BLDG. 2100-1 WICHITA. KS 67226 316-687-2102
Sp..lect Sheet
Page 2
Fort Riley "Special Sections:"
Yes, the above-mentioned terminal IJas underground facilities in
Fort Riley. Please tJ:pnsmitlocate l"equests for this region.
( /'---)
No, the above-mf'mtioned terminal does not have underground
facilities in Fort Leavenworth. Therefore, we do not need to
receive any locate requests. for this region.
.Je[ (erson and Shawnet:! Counties Indian Reservation Areas:
Please indicate with <Ill "X" in which reservation numbers your com-
pany has underground facilities.
) Reservation Numh~r 1
) Reservation Numher 2
) Reservation Number 3
) Reservation Number 1
) Reservation Number 5
) Reservation Number 6
) Reservation Number 7
) Reservation Number B
) Reservation Numb~r 9
) Reservation Number 10
) Reservation Numhp.t" 11
) Reservation Number 12
)q There are no f<1cilities in the above-mentioned reservation
areas.
(
(
(
(
(
(
(
(
(
(
(
(
Completed By:
Sign<1ture:
Phone Number:
(
(
(
(
(
(
(
(
(
(
(
) Reservation Number 13
) Reservation Number 14
) Reservation Number 15
) Reservation Number 16
) Reservation Number 17
) Reservation Number 18
) Reservation Number 19
) Reservation Number 20
) Reservation Number 21
) Reservation Number 22
) Reservation Number 23
~ 7J.f cJ
D^TA BASE UPDATED BY:
(FOR CALL CENTER PERSONNEL ONLY)
DATE:
KANSAS ONE-CALL SYSTEM, INC.
COUNTY DATA BASE SHEET
() I 1f:. .gj .S'~! :,. Ci . I DATE ;2g~clu
COMPANY NAMEf/:'" rg I~ c;, ... /"~t! TERMINAL IDS A L 111,' A & I
"~
PLACE AN NX" IN ALL COUNTI S WHERE YOU HAVE FACILITIES. .' i'"
( ) ALLEN ( ) GREELEY ( ) OSBORNE
( ) ANDERSON ( ) GREENWOOD ( ) OTTAWA
( ) ATCHISON ( ) HAMILTON ( ) PAWNEE
( ) BARBER ( ) HARPER ( ) PHILLIPS
( ) BARTON ( ) HARVEY ( ) POTTAWATOMIE
( ) BOURBON ( ) HASKELL ( ) PRATT
( ) BROWN ( ) HODGEMAN ( ) RAWLINS
( ) BUTLER ( ) JACKSON ( ) RENO
( ) CHASE ( ) JEFFERSON ( ) REPUBLIC
( ) CHAUTAUQUA ( ) JEWELL ( ) RICE
( ) CHEROKEE ( ) JOHNSON ( ) RILEY
( ) CHEYENNE ( ) KEARNY ( ) ROOKS
( ) CLARK ( ) KINGMAN ( ) RUSH ,
( ) CLAY ( ) KIOWA ( ) RUSSEll L I ~
( ) CLOUD ( ) LABETTE (X') SALINE 6 t.'\,
( ) COFFEY ( ) LANE ( ) SCOTT
( ) COMANCHE ( ) LEAVENWORTH ( ) SEDGWICK
( ) COWLEY ( ) LINCOLN ( ) SEWARD
( ) CRAWFORD ( ) LINN ( ) SHAWNEE
( ) DECATUR ( ) LOGAN ( ) SHERIDAN
( ) DICKINSON ( ) LYON ( ) SHERMAN
( ) DONIPHAN ( ) MCPHERSON ( ) SMITH
( ) DOUGLAS ( ) MARION ( ) STAFFORD
( ) EDWARDS ( ) MARSHALL ( ) STANTON
( ) ELK ( ) MEADE ( ) STEVENS
( ) ELLIS ( ) MIAMI ( ) SUMNER
( ) ELLSWORTH ( ) MITCHELL ( ) THOMAS
( ) FINNEY ( ) MONTGOMERY ( ) TREGO
( ) FORD ( ) MORRIS ( ) WABAUNSEE
( ) FRANKLIN ( ) MORTON ( ) WALLACE
( ) GEARY ( ) NEMAHA ( ) WASHINGTON
( ) GOVE ( ) NEOSHO ( ) WICHITA
( ) GRAHAM ( ) NESS ( ) WILSON
( ) GRANT ( ) NORTON ( ) WOODSON
( ) GRAY ( ) OSAGE ( ) WYANDOTTE
8700 East22nd Street North . Wichita, KS 67226 . 7-376-687-2702
. . ~V:~i
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KANSAS
ONE-CALL
SYSTEM. INC.