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Page 1 <br /> WOI'�( IQCtIVIt�/ WOI'�( �1'C�@I' iz/iz/zoi� �:a� <br /> ISSUBd BY CSG CAVANAH,SHANE G. <br /> issued Department Pw PUBLIC WORKS <br /> Date Issued �o�3v2o�2 Activit <br /> Fund nai Account s Program ��o Function i�9 y e�s <br /> Program <br /> Tltl@ REPAIR.751NCH 10905 3RD AVE SE 710179675 <br /> WOfk OfdOf NO 2��2z4$$ PfOJECf Activity Type CORRECTIVE MAINTENANCE Sf81US CL <br /> Sf8tU5 10131I2012 TIR18 74t21 OfiSlf181 WO _ _ _ __Bllllfl9 _ . . <br /> Customer Information Customer ld <br /> Customer Name <br /> Address Street <br /> Aparlment No City <br /> State 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 Street <br /> From Cross Street <br /> To Cross Street <br /> City ZiP <br /> SuCdivision Map Book Map Reference <br /> Problem <br /> Sub Problem Date Requested <br /> Requested By Related Request <br /> Agency <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept Priority Estimated Hours <br /> C rew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Dale To Be Comp Date <br /> Scheduled Date _ Scheduled Time _ <br /> Route Route Sequence <br /> Comments <br /> Action Taken REPAIREO SERVICE AND RECONNECTED TRACING WIRE. <br /> Recommended Action <br /> Approved By soc sMirH,onvio G. Job Cost Information(Y/N) <br /> ----- Permit No <br /> Start Date � � Time Date Completed �inizo�2 __— _ <br /> -- —---- <br /> -- - -_ _ <br /> — . <br /> Completed By Time Follow p _ _ _ <br />