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Work Activity 4Nork Order Page � <br /> ��3i�2oi4 ii:ii <br /> ISSUed By HLJ HUSBY,LANCE J, v ` <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued �ivzo�a <br /> Fund aot Account s Program Function Activiry <br /> Program UT3473 a 3 <br /> TI110 CONVERT.75 INCH 205 BRIDGEWAY UT3473-0•3 <br /> Work Order No 20142067 Project Activity Type CORRECTIVE MAINTENANCE $tafUS CL <br /> Status �iyzota Time te:n Original WO Billing <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Street <br /> A�artment No City <br /> Slate Zip <br /> Subdivision Change Map Y/N <br /> Phone No ( ) - Ext <br /> Second Phone ( 1 • Ext - <br /> E-Mail Address <br /> Problem Information <br /> Address yps Street BR/DGEWAY <br /> From Cross Street <br /> To Cross Slreet <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem WATEft WATER <br /> Sub Problem OTHER OTHER <br /> Requested By Date Requested <br /> Agency Relaled Request <br /> Initiated From <br /> Utility Locate (USA) No Called Dale Expiralion Dale <br /> Assignment Infortnation <br /> Dept Priority Estimated Hours <br /> C rew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Dale ___ __ To Be Comp Dale __ _ <br /> � : '1- : , �•;, :';, :, . : <br /> ,.� ,�J:i '.� :�-,�; '_�: ,� <br /> Scheduled Date Scheduled Time ' . <br /> Route Route Sequence <br /> Comments <br /> Action Taken CONVERT.751NCH CURBSTOP TO.751NCH SETTER WITH METER AND BOX.FLAT TO METER <br /> PROJECT <br /> Recommended Action <br /> Approved By Hw riusov,u�Nce�. Job Cosl Information(Y/N) <br /> Start Date ! I Time Date Completed ��eno�4 Permit No <br /> Compieted �y Time Follow Up? <br />