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Work Act�vity Work Order <br />� <br />�ILL J4B <br />r.�,�„ i <br />s/31/2005 14:0'1 <br />ISSU2d By WMW WARD, MICHAEL W. <br />Issued Department Pw PUBLIC WORKS <br />Date Issued 5is�2aos <br />Fund aot Account 5 Program »o Funclion »y Activity ese <br />Program <br />Title S021NCH B223DROADWAY 710119664 <br />WOfk OfdBf NO 20090038 PfOJOCt ACtiVlly TypO CORRECTIVE MAINTENANCE SfBtUS CL <br />SlaWs vsizoos Time os:as Onginal WO saiza2s Dillinc� <br />Customer Information <br />Customer Name <br />Address <br />Apartment No <br />State <br />Subdivision <br />Phone No ( > <br />Second Phone ( 1 <br />E-Mail Address <br />Problem Information <br />Address 8223 <br />From Cross Street <br />To Cross Streel <br />City <br />Subdivision <br />Problem <br />Sub Prablem <br />Reques�ed f3y <br />Agency <br />Initiated From <br />Uliliry Locate (USA) No <br />Assignment Information <br />Dept <br />Crew <br />Contractor <br />Assigned To <br />Assigned By <br />Slreet <br />Cily <br />Zip <br />Ext <br />Ext <br />Street BROADWAY <br />Map Bool< <br />Called Date <br />Assigned Dale To [3e Comp Date <br />Scheduled Date Scheduled Time <br />Route Route Sequence <br />Comments BILLJOB.COSTESTIMATEDONE. <br />Customer ld <br />Change Map Y/N <br />Zip <br />Map Re(erence <br />Date Requested <br />Related Request <br />Expiration Date <br />Priority Estimaled Hours <br />ACtlOfl T0k¢I1 DCDA INSTALLED INSIDE BUILDING POR PROTECTION I'URPOSES. <br />Recammended Action <br />ApprOvOd By WMW WARD, MICHAEL W. <br />Start Date � i Time <br />Completed By <br />Job Costlnformation(Y/N) <br />Date Completed y�vzoos Permit No <br />Time Follow Up? <br />�J <br />