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Work Activity Work Order Pa9e I <br /> �ii�izoa� s:zz <br /> ISSUed BY CAG CRU�A.GERRY <br /> Issued Deparlment Pw PUBLIC WORKS <br /> Date Issued 9112/2005 <br /> Fund aot Account s Program »o Function »s Activiry ss4 <br /> Progrem S38Z`� <br /> Tl�le 50.75 INC4 BB4t 3RD AVE SE 710119664 <br /> WCfk OfdBf NO 20050683 PfOjeCt Activity Type CORRECTIVE MAINTENANCE SletUS CL <br /> Date snv2oos Time ossn _ Originai WO ti�a3 ___ Billing __ <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Street <br /> Apartmenl No Cit, <br /> Slale Z�P <br /> Subdivision Cliange Map YIN <br /> Phone No ( � - Ext <br /> Second Phone ( 1 - Ext -- <br /> E-Mail Address ___ __ _ _ <br /> Problem Information �BL� <br /> Address �B4d� Street 3RD AVE SE <br /> From Cross Street <br /> To Cross Street <br /> Ciry �ip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requesled By Date Requested <br /> Agency Related Request <br /> Iniliated From <br /> Utiliry Locate(USA) No Called Date Expiration Date <br /> Assignment Informatlon <br /> Dept Priority Eslimated Hours <br /> Crew <br /> Conhactor <br /> Assigned To <br /> Assigned dy <br /> Assigned Date To Be Comp Dale <br /> Scheduled Dale Scheduled Time __ <br /> Roule Roule Sequence <br /> Comments <br /> ActionTaken - - — -- ------ — — ---- ------- <br />