This form is currently designed to send the event data to North Carolina 811. This form is not a one-call ticket and is not transmitted to members. This is for data collection only. Your data will be held securely and will be released only by written request. You are free to distribute this form to anyone at your company who may register damage information. You must also contact the affected facility to arrange for repair. If your damage results in a life-threatening emergency, please call 911.
Part A - Who is submitting this information *
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