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� GTY OF EVEREI I �. • " -= -, . . . <br /> • DEPARTMENT OF PUBUC WORKS �9 �uMMg � 1 <br /> :., g'33�j <br /> , c.�. <br /> UTILITIES DIVISION W,p. No. <br /> Acct. No. �� 5 `r19 <br /> Complaint No. _� <br /> UTILITY WORK ORDEi� <br /> -� [��Q� � WATER � SERVICE � MAINTENANCE <br /> Date: _�r—� ❑ MAIN � OPERATION <br /> ❑ SEWER <br /> ❑ STORM ❑ PUMP STATION ❑ REPAIR <br /> ❑ TREATMENT ❑ CONSTRUCTION <br /> ❑ RESERVOIR <br /> f <br /> ❑ VALVE <br /> � <br /> ❑ MAN HOLE i <br /> ❑ CATCH BASIN <br /> ❑ DITCH <br /> �oc:�tion: � L G — <br /> r�nn i�ri v ���✓� !�� � � :. <br /> W.O. Instructions: : � <br /> � <br /> � <br /> 6 <br /> � <br /> i <br /> i <br /> n I <br /> ACTUAL • /`S I <br /> ESTIMATED { <br /> Labor(hours) • ' <br /> Labor(hours) . ' <br /> Material (cost) • <br /> Material (cost) • <br /> Equipment (cost) : <br /> Equipment (cost) : -" <br /> SCHEDULING REQUESTED <br /> LABOR, EQUI MENOTUAND MABERIA S ON REVERSE SIDE. E SLIPS. ITEMIZE <br /> Completion (Date): <br /> �i17� �q Cost:$_ <br /> Charge Account Number:�----Charge Cost To (Name): <br /> � Zip:. <br /> Address: <br /> Amount:S <br /> Date: — <br /> Invoice No.: <br /> , . <br /> es .. . . . . -- __ - <br />