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NO MqTERIqLS <br /> Work Activity Work Order Pege 1 <br /> 12/28/2011 15:55 <br /> ISSU2d By VYMN/ WARD,MICHAEL W. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued t�sc��ott <br /> Fund �o� Account s Program »o Function »a Activity s» <br /> Program <br /> Title KILI 21NCH BLOW Oh"F 5020 CHINOOK DR 710179671 <br /> WOfk Ofd@f NO 2����259 Project Actrvity Type CORRECTIVE MAINTENANCE S10�U5 CL <br /> Status �izsnon Time ta t� Original VJ0 _ Billing _ _ <br /> Customer Infornatlon <br /> Customer Narr�e Customer lo <br /> Address Street <br /> Apartm2nt No ��•Y <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> Phoiie No l ) • L=xt <br /> Second Phone 1 ) • Ext -- <br /> E-Mail Address <br /> Problem Information <br /> Address 50?0 S�� CHINOOK DR <br /> From Cross Stree <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Related Request <br /> Initiated From <br /> Utihty Locate (USA) No Called Date Expiration Oate <br /> Assignment Informatlon <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contrar.tor <br /> Assigned To <br /> Assigned By <br /> Assigned Date To Be Comp Date <br /> Scheduled Date Scheduled Time <br /> Route Route Sequence <br /> Camments <br /> Actlon Takon KILLED BLOW OFF DURING CONNECTION TO NEW MAIN.WORK ORDER I20111258. <br /> Rccommended Actlon <br /> App�OvOd By BGM2 6EUKERS.GEORGE M. JOb COSI IflfOffT18N0�(Y/N) <br /> ---- --- --- <br /> Start Date � � Time Date Completed tve�so�t Permit No <br /> -- – — <br /> Completed By Time Follow Up?_ <br /> IZ <br />