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� <br /> Work Activity Work Order �a�� � <br /> ioi3; _c,;s ,, . <br /> ISSl12d By CAG :RUk,GERRY � <br /> Issued Depa�trnenlpw f�UBLICWOFKS <br /> Dale Issued sn�zaos <br /> Fund ao� Account s Program �to Function ��y Achvity bbq <br /> Program <br /> Tille 50751NCH26208ROADWAY 710N966i <br /> WOrk OfdO�NO 2��50862 PfOjOCI ACfiVlty TypB CORRECTIVE tAAINTENANCE StalUS CL <br /> Dale 9n�2oo5 Timet3:se Original WO ti�3a Biiling <br /> Customer Information <br /> Cuslomer Name Customer ld <br /> Address Street <br /> Apartment No City <br /> State Zip <br /> Subdivision Change Map YIN <br /> Phone No ( 1 • Ext <br /> Second Phone ( 1 - Ext <br /> E Mail Address <br /> Problem Infonnation <br /> Address Zgpp Street BROADWAY <br /> From Cross Slreet <br /> To Cross Street <br /> Cdy Zip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Probiem <br /> Requesled By Date Requested <br /> Agency Related Requesl <br /> Initialed From <br /> Utility Locate(USA)No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date To Be Comp Date <br /> Scheduied Date Scheduled Time <br /> Route Route Sequence <br /> Comments <br /> Action Taken IN BACK OF SIDEWALK:3'SOUTH OP NURTH PROPERTY LINE OFF BROADWAY <br /> COf11�ICt8d By KTJ KELSO,THOMAS J. JOb CC,SI IflfOff118110f1(Y/N) <br /> Start Date i I Tim.e Date Completed gryg�q005 Time <br /> Approved By Follow Up? Permit No <br /> Problem Details ��/ <br /> / <br />