Please complete and then press the Send button. When we receive the notes, we will make an outline estimate and send it to you.

I understand that I will receive an outline estimate and not a fixed price quotation.	Yes      No
Name
District
Canal Length (in miles/feet)
Width Across the Bottom of the Canal
Height of the Sides
Size of concrete panels or other information about the concrete
The cracks are on only one side?	Yes      No
The cracks in the panel joins are?	‭Horizontal      ‭Vertical
One main crack that runs along the side/s?	Yes      No
Several cracks run along the side/s?	Yes      No
There are hairline cracks in addition to the larger cracks?	Yes      No
Some of the cracks have become very deep?	Yes      No
‭There is a crack that runs between the bottom and the sides?	Yes      No
Would you rate your cracks as?	‭ Not too bad Worsening Medium bad Worse than medium bad Severe
Water is leaking from the canal?	Yes      No
How much water is leaking from the canal? please enter the amount here.

Please complete and then press the Send button. When we receive the notes, we will make an outline estimate and send it to you.

I understand that I will receive an outline estimate and not a fixed price quotation.	Yes      No
Name
District
Canal Length (in miles/feet)
Width Across the Bottom of the Canal
Height of the Sides
Size of concrete panels or other information about the concrete
The cracks are on only one side?	Yes      No
The cracks in the panel joins are?	‭Horizontal      ‭Vertical
One main crack that runs along the side/s?	Yes      No
Several cracks run along the side/s?	Yes      No
There are hairline cracks in addition to the larger cracks?	Yes      No
Some of the cracks have become very deep?	Yes      No
‭There is a crack that runs between the bottom and the sides?	Yes      No
Would you rate your cracks as?	‭ Not too bad Worsening Medium bad Worse than medium bad Severe
Water is leaking from the canal?	Yes      No
How much water is leaking from the canal? please enter the amount here.