Groundbed Design and Request Worksheet

A site visit is required for picture documentation, we include pictures enhanced with measurement and reference information for planning and estimation purposes.

Be sure to compile all needed information before completing the below form as you can not save a partially completed form.

Company Name:

Street Address:

City, State and Zip Code:

Department:

Contact Name:

Contact Phone:

Contact Email:

Installation Date:

Groundbed Type: DeepConventionalDistributive

AFE Number:

New or Redrill: NewRedrill

CPS Number:

Pipeline District:

Line Name and Number:

Milepost:

County:

State:

GPS Latitude:

GPS Longitude:

Elevation:

Casing Diameter (PVC cemented in place):

Casing Depth (subject to TNRCC approval):

Hole Diameter:

Hole Depth:

Vent Pipe (1" PVC):

Perforated Vent (1" All PVC Vent):

Number of Anodes:

Pit Requirement:

Rectifier Manufacturer and Model:

Capacity: DCVDCAACPhase

Anode Type:

Anode Cable:

Pos-Neg Cable:

Backfill Material:

Positive Junction Box:

Guardrail Present:

Cement Pad:

Hole Completion:

Power Company Name:

New Meter Loop:

Service Pole:

Negative Junction Box:

Special Instructions, if needed: