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i <br /> Work Activity Wark Order Pa9� 1 <br /> �ne�2ois 4:a� <br /> ISSUEd BY SJT2 SPOONER,JAMES T. <br /> Issued Department aw PUBLIC WORKS <br /> Date Issued 611 012 0 1 5 <br /> Fund ao� Account s Program Function Activity <br /> Program uT3a�a e a <br /> TIIIQ CUNVERT.75 INCH 1715 B LOMBARD AVE UT3473-5-3 <br /> Worh Order No 20151333 PfOJEC1 Activiry Type CORRECTIVE MAINTENANCE SI3lU5 CL <br /> Status 5nono�5 Time t3 �____Original WO _ Billing_ _ _ <br /> Customer lnformation <br /> Customer Name Customer ld <br /> Address Street <br /> Apartment No Ciry <br /> Stata ZiP <br /> Subdivision Change Map YIN <br /> Phone No c � - Ext <br /> Second Phone ( 1 - Ext -- — <br /> E-Mail Address <br /> ---- - --_ -- <br /> Problem Information <br /> Address 17�5 g Street LOMBARD AVE <br /> From Cross Street <br /> To Cross Slreet <br /> City Zip <br /> Subdivision Map Book Map Reference <br /> Problem WATEk WATER <br /> Sub Prablem OTHE2 OTHER <br /> ReGuested By Date Requested <br /> Agency Related Request <br /> Iniliated From <br /> Utility Locate (USA) No Calied Date Expiretion Date <br /> Assignment Iniormation <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date ___ To Be Comp Date i��,�!L:;i,s c� ��� J_ ���,',1,'� �L, <br /> Scheduled Date Scheduled Time <br /> Route Route Sequence <br /> Comments <br /> Action Taken CONVERT.75 INCH CURBSTOP TO .75 INCH SETTER WITH METER AND BOX. FLAT TO METER <br /> PROJECT. <br /> Recommended Action <br /> Approved By HLJ HUSBY,LANCE J .lOb COSf If1(Off110fi00(Y/N) <br /> Start Date r � Time Date Completed 5noizois _ Permit No ___ <br /> Completed By Time Follow Up? <br />