AMS Utilities close out package

• Site Name:

• Site ID:

• Location
  Address

• Prepared by

• Conducted on

  Date

Construction

• Start Date:

  Date

• End Date:

  Date

• In-house Crew or Contractor? Please specify.

  In-House

  Contractor

Scope of Work

Media (Pre/During/Post)

• Facility Pictures

  Media

• Trench/Bore

  Yes

  No

  N/A

• Construction Pictures Before

  Media

• Construction Pictures During

  Media

• Construction Pictures After

  Media

• Tap in installation

  Yes

  No

  N/A

• Construction Pictures Before

  Media

• Construction Pictures During

  Media

• Construction Pictures After

  Media

• Pictures of Dig Ticket

  Media

• Reference #

• Pictures of Located Utilities

  Media

• Special Remarks

• Additional Instructions or Pictures

  Yes

  No

  N/A

As-builts

• Pictures of marked up plans

  Media

Inventory

• Riser

• Conduit Footage

• Flow stop

• Tracer Wire

• Fusion coupling

• Crimp on coupling

• No blow saddle

• Misc. Pictures

  Media

Sign-off

• Auditor's signature

  Sign