Precaster:		Contact:		Date:
Project:		Contractor:		PO#:
Special Instructions:

TAKE OFF & ORDER SHEET FOR GU MANHOLE BASE LINERS

MANHOLE#:

Diameter:

Wall

5"

8"

GU BASE LINER CONFIGURATION:

Main channel invert diff:*

inch

Standard:

Yes

No

	Degree	Invert Elev*	Slope*%	Type	Class	Size
Pipe Outlet	0°							Standard
Pipe Inlet							Channel *	Yes	No
1st Lat/Pipe
2ndLat/Pipe
3rd Lat/Pipe

Height from skirt return to main channel outlet*: inch			date required
Extended skirt*: inch			barrel lined yes no
RIM Elev.: