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USA North Ticket Form Call 811 Enter your ticket at www. usanorth.org or Click the Single Address Ticket Entry button. Call 2 Working Days to 14 Calendar Days Before You Dig Serving Central and Northern California and all of Nevada Business Phone Fax Email Address Your Name Your Company Name Type Industry Company s Address City State Zip What County is your work being done in Will any of your excavation work include Night Work And/or Weekend Work Start Date 2 working day to 14 calendar day notice required Start Time Working For As required has site been premarked Premarked method used Permit Type Permit Foreman s Name Cell Tel Field Tel Does your excavation include boring if so what type Type/Nature of Work augering drilling grading ripping trenching etc. Will Explosives be used at your work site Do you intend to use vacuum equipment instead of hand digging to determine the exact location of our member s underground facilities Digsite Place City or Community Digsite Types Include side of street footages other tie in measurements or lat/long in NAD 83 CONUS decimal format More digsite information is available in the USA North Excavation Manual for your State. I. Street/Address es II. Intersections III. Between Intersections IV. Bounded by Area contains no streets on map within the excavation area V. Mile Post Markers MP Must be on the same Hwy list MP as from to or a single pt. Hwy Green MP White MP Green MP White MP Will the excavation enter into the street or sidewalk area Ticket Date Expires Update by Calling hours are from 6 a*m* - 7 p*m* Mon - Fri excluding weekends and USA North s holidays. For easy access to 24/7 ticket entry call 1-800-640-5137 ext 2309. More details for this form are available at www. I. Street/Address es II. Intersections III. Between Intersections IV. Bounded by Area contains no streets on map within the excavation area V. Mile Post Markers MP Must be on the same Hwy list MP as from to or a single pt. Hwy Green MP White MP Green MP White MP Will the excavation enter into the street or sidewalk area Ticket Date Expires Update by Calling hours are from 6 a*m* - 7 p*m* Mon - Fri excluding weekends and USA North s holidays. Mile Post Markers MP Must be on the same Hwy list MP as from to or a single pt. Hwy Green MP White MP Green MP White MP Will the excavation enter into the street or sidewalk area Ticket Date Expires Update by Calling hours are from 6 a*m* - 7 p*m* Mon - Fri excluding weekends and USA North s holidays. For easy access to 24/7 ticket entry call 1-800-640-5137 ext 2309. More details for this form are available at www. I. Street/Address es II. Intersections III. Between Intersections IV. Bounded by Area contains no streets on map within the excavation area V. Mile Post Markers MP Must be on the same Hwy list MP as from to or a single pt. Hwy Green MP White MP Green MP White MP Will the excavation enter into the street or sidewalk area Ticket Date Expires Update by Calling hours are from 6 a*m* - 7 p*m* Mon - Fri excluding weekends and USA North s holidays. For easy access to 24/7 ticket entry call 1-800-640-5137 ext 2309. More details for this form are available at www.

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