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Page 1 <br /> Work Activity Work Order 3/15/2013 �4:45 <br /> ISSUOd BY CSG CAVANAH,SHANE G. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued 111 612 0 1 3 Activi 675 <br /> Fund aot Account s Program �to Function t�B ty <br /> Program <br /> TIII@ REPAIR.751NCH1628ROCKEfELLERAVE710179675 <br /> WOfk Ofd2f NO 20130189 PfOJeCI Activity Type CORRECTIVE MAINTENANCE Sf2�U5 CL <br /> St8it15 1l16/2073 _Tlfll2 0033_ Ofi91f181 WO _. _ _ BIIIIl19 ____ _.—— <br /> Customer Information Customer id <br /> Customer Name <br /> Address Street <br /> Apartment No City <br /> Slate Z�p <br /> Subdivision Change Map Y/N <br /> Phone No ( ) - Ext __ _-_------- <br /> Second Phone ( ) - Ext <br /> E-Mail Address -" <br /> Problem Information <br /> Address 1628 Street ROCKEFELLERAVE <br /> From Cross Street <br /> To Cross Street ZiP <br /> City Map Book Map Reference <br /> Subdivision <br /> Problem <br /> Sub Probiem Date Requested <br /> Requested By Related Request <br /> Agency <br /> Initiated From Ex ' ation Date <br /> Utility Locate (USA) No Called Date F' <br /> Aesignment InFormation <br /> Dept Priority Estimated Hours <br /> Crew <br /> Contractur <br /> Assigned To <br /> Assigned By To Be Comp Date <br /> Assigned Date __ _ _ - <br /> Scheduled Date _ Scheduled Time <br /> Route Route SPquence <br /> Comments <br /> Action Taken REPLACE .75 INCH CUR85TOP WITH.751NCH SETTER,JUMPER AND BOX. <br /> Recommended Action <br /> Approved By wo� WEAVER, DEAN L JOl7 COS�Ifl(Offi18110(1(YIN) _ <br /> Time Date Completed 111 612 0 1 3 Permit No _ <br /> Starl Dz�e ! � _-- — <br /> - - - Time Foliow Up7_ __-- <br /> Completed By _ -- — <br />