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�Q �1I��TG �����.� <br />Page 1 <br />Work Activity Work Order a,zl,zal, ��:5, <br />ISSU2d By CSG CAVANAH, SHANE G. <br />Issued Department Pw PUBUC WORKS <br />Date Issued eizvzo�a Activi <br />Fund aot Account s Program »o Function ��9 �y e�s <br />Program REPAIR .75 1NCH 121 SE EVER[TT MALL WAY 710119675 <br />Title <br />VJork Order No 2��320a5 PfOJBCt Activity Type CORRECTIVE MAINTENANCE Sl8fU5 CL <br />Status e�zvzoia _Time is:ao__ Original WO_ _ Billing __ __ ____ _._ - <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 121 <br />From Cross Street <br />To Cross Street <br />City <br />Subdivision <br />Problem <br />Sub Problem <br />Requested By <br />Agency <br />Initiated From <br />Utility Locate (USA) No <br />Assignment Information <br />Dept <br />C rew <br />Contractor <br />Assigned To <br />Assigned By <br />Assigned Date __.__ ___ <br />Scheduled Date _ <br />Route <br />Comments <br />Action Taken REPAIRED SERVICE. <br />Recommended Action <br />Customer ld <br />Street <br />City <br />Zip <br />Ext <br />Ext <br />Street SE EVERETT MALL WAY <br />Map Book <br />Called Date <br />To Be Comp Date <br />Scheduled Time <br />Route Sequence <br />Zip <br />Prioriry <br />Change Map Y/N <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Estimated Hours <br />Approved By DOL DRASZT, DAVID L. <br />Start Date i � Time ___ Date Completed <br />----- <br />Ccmpleted By _ Time <br />Job Cost information(YIN) <br />enano�a _ Permit No <br />Follow Up? __. <br />