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Work Activity Work Order `'�" �� <br /> :�. _�.., . _- <br /> ISSU2d B/ HLJ � � HUSBY, LANGE J. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued 12l912015 <br /> Fund aoi Account 5 Program FuncUon Activi;y <br /> Program uraa�a e � <br /> Tdle COhVERT 75 INCH 2725 LO�dBARD AVE UT3473-8-3 <br /> Work Order No 20152648 FfOfOCt Activdy Type CORRECTIVE MAINTENANC[ SI2�U5 CL <br /> Status �z�9i�oi5 Time orii Original WO Billing <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Stree( <br /> Aoartmenl No C�ty <br /> State Z�p <br /> Subdiv�sion Change Map YR� <br /> Phone PJo � 1 - Ex! <br /> Second Phone � � - Ext — <br /> E-Mad Addre=_s <br /> Problem Information <br /> Address 27p5 Street LOMBARD AVE <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subd�vision Map Book Map Reference <br /> Problem WATER WATER <br /> Sub Prablem OTHER OTHER <br /> Requested By Date Requested <br /> Agency Relafed Reyuest <br /> Indiated From <br /> Utility Locate (USA) No Called Date Expiralion Date <br /> Assignment Information <br /> Dept Prionty Estima:ed I lours <br /> Crew <br /> Contractor <br /> Ass�gned To <br /> Ass�gnetl By �1� �. ��+ � r � , <br /> Assigned Date --_– To Be Comp Dale " �n "..� �� ,.,I����;�$' <br /> Scheduled Dale Scheduled Time _ _ _ _ <br /> Route Route Sequence <br /> COfnnlCnlS INVENTORY MAT[I21AL IN THE AMOUNT OF S45J8.05.'NAS JOURNALIZED <br /> W 2015 <br /> Action Taken CONVERT ]5 INCH CUR�STOP TO 75INCH SETTTER WITH M17ETER AND BOX. FLAT TO METER <br /> PROGRM.t. <br /> Recomme�ded Action <br /> Approved By Ep� Eaic�soN, nNortFw� Job Cost In(ormalion(Y1N) <br /> Slart Date i i Time Date Cempleted iziianois Permit No <br />