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Backfill Inspection Report Form
New
R.R.
Road
Existing
River Bed
OR
Depth New PL
Depth Existing
Depth
FACILITY
Depth
Existing
Cased
Uncased
Grade
Pipeline – R/W
1. Depth to existing line (on elevation)
2. Depth to new line above or below existing line (on elevation)
3. Cathodic protection installed: YES NO
If yes, what type of protection?
Owner of foreign or existing facility:
Size and condition of existing facility”
(New) oil, gas, water, etc.:
Contractor doing work:
Approval
Print Name
Date...
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