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NON-COMPLIANCE REPORTING FORM

If you see someone digging and do not see any marks, please complete this form or click here to view/print a blank form and we will investigate.

Press the SUBMIT button to send the form when completed.

Contractor's Information:
Name:
Address:
City:
State:
Zip Code:
License Plate Number:


Exact location of excavation:
Borough/Town:
Address:
City:
State:
Zip Code:
Two adjoining intersections:
Date of Witnessed Excavation:
Time:


Other unusual improper activities observed?


   

Explanation:


Was any One Call notice given for this work?
   

Ticket #:

If 'Yes', was notice in compliance with prescribed time limits?




In the event additional information would be required and to enable us to send you a copy of the formal complaint issued to the contractor and enforcement agencies, please provide us with the following information.

Your Name:
Your Address:
City:
State:
Zip Code:
Email Address:
Phone Number
(with area code): 		 ( ) -
Fax Number
(with area code): 		 ( ) -

Please keep this information confidential.


This information will be kept confidential at your request.

 
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