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�. <br /> , .� r .,� , f , , � n� <br /> Y. � . 4 i 1 <br /> Work Activity Work Order : <br /> ISSued By WMW WARD,MICHAEL W. <br /> Issued Department PW PUBLIC WORKS <br /> Datelssued anznooe <br /> Fw,d qo� Accounl 5 Program 7�o Function »y Activdy 6s4 <br /> Program <br /> Tille SO B INCH 2208 W CASINO RU 770119664 <br /> WOrk Ofder NO 2��8�650 PfOJeCI AClivity Type CORRECTIVE MA�NTENANCE SlatuS CL <br /> Date envzooe Time io:�s Original WO 2ooeo�a9 Billing <br /> Customer Information <br /> Cuslomer Name Customer ld <br /> Address Street <br /> Aparlmenl No City <br /> Stale Z�P <br /> Subdivision Chacae Map Y/N <br /> Phone No � 1 - Ext <br /> Second Phone 1 1 - Ext <br /> E-Mail Address <br /> Problem Information <br /> Address pppg Street W CASINO RD <br /> From Cross Streel <br /> To Cross Street <br /> Ciry Z�P <br /> Subdivision Map Book Ma{� Reference <br /> Problem <br /> Sub I'roblem <br /> Requested By Date Requested <br /> Agency Retated Reque�! <br /> Initialed From <br /> Utiliry Locate (USA) No Called Dale Expiration Date <br /> Assignment Informatfon <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contrac�or <br /> Assigned To <br /> Assi,yned By <br /> Ass�gned Date To Be Comp Date <br /> Scheduled Date Scheduled Time <br /> Route Route Sequence <br /> Camments BILL JOB.COST ESTIMATE•SOUTH CONNECTION <br /> Action Taken CONTRAGTOR SUPPLIED ALL PARTS.TIME AND VEHICLES ONLV ON WORK ORDER. <br /> Cornpleted By WMW �'ARD, MICHAEL W ApPfOVBd BY <br /> Start Date i � Time Date Completed en7itooe Time <br /> Job Cost Informahon(Y/N) Follow Up? Permit No <br /> Problem Delalls ��� <br />