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VVorH Activity Work Or�ler <br />ISSUBd By N50 ;JIELSEN, SCOTT O. <br />Issued Department Pw PUBLIC WORHS <br />Daie Issued v25�zoos <br />Fund 40� Accounl s Program �to Function tte Rctiviry 675 <br />Program <br />TIfIC REPlUR 5721 LOMBARD AVE 710179G75 <br />Work Order No 2��902�6 PfUJBCf ACIIVIIy TypC SERVICE REQUEST SlBlUS PR <br />Stafus znsroos Time os:ti Original WO F3illing <br />Customer Information <br />Cuslomer Nam� VINCE LONG Customer ld <br />Address 5721 SIfCCI L01d8ARD AVE <br />�parlment No Ciry <br />Slate ZiP <br />Subdivision Change Map Y/N <br />Phone No ( a2s 1 aar-zeas Ext <br />Second Phone ( 1 - Ext <br />E-Mail Address <br />Problem Information <br />Address g7P1 S�reet LOMBARD AVE <br />From Cross Slreel <br />To Cmss Street <br />City Zip <br />Subdivision Map Book Map Reference <br />Problem WATER WATER <br />Sub Problem <br />Requesled By s.17 SKAGEN, JEFFREY T. DOfC ReqUCSiBd 2�zsnnos <br />Agency Related Request 000ne�s <br />Initialed From PUBLIC t�ueuc <br />Utility Locale (USA) No Called Date Expiralion Date <br />Assignment lnformation <br />Dept rw PUBLIC WORKS Priority Estimated Hours <br />Crew <br />Contractor <br />Assigned To MTL2 l�1ARI<HAId. Tlh!UTHY L. <br />Assigned By <br />Assigned Date To Be Comp Dale <br />Scheduied Date Scheduled Time <br />Route Route Ser �ence <br />Comments <br />Action Taken pREVIOUSLY REPAIRED SERVICE REPAIRED AGAIN. WILL REPLACE FROM MAIN. <br />Recommended Action <br />Approved By Job .osl Information(Y(N) <br />Starl Date � � Time Date Completed a��,��� � Permit No <br />Completed [3y j, `-�(,(5 �( Time Follow Up? <br />� � <br />,���,,��,���� �,�� us�� a ��s�� ������� K���s <br />