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Page 1 <br />Work Activity Work Order 12,z9,2o11 e:o, <br />ISSl18d BY WM�'1 � WARD, MICHAEL W. <br />ISsued DepartmentPw PUBLICWORKS <br />Date Issued ensi2o�� Activi <br />Fund aot Account 5 Program �to Function tte �Y 664 <br />Program <br />TiIIB SO .75 INCH SFR 9203 4TH AVE W 710119664 <br />WOfk Ofdef NO 2���2299 PfOjeCt ACIIVity TypO CORRECTIVE MAINTENANCE St8tU5 Cl <br />Status ens�zoti Time �e:oi Original WO t3t�e __ Billing_ __ _--. <br />Customer Information <br />Customer Name <br />Address Street <br />Apartment No City <br />State Z�p <br />Subdivision <br />Phone No ( ) - Ext <br />Second Phone ( ) - Ext <br />E-Mail Address <br />Problem Information <br />Address 9203 Street qTH AVE W <br />From Cross Street <br />To Cross Street <br />City <br />Subdivision Map Book <br />Problem <br />Sub Problem <br />Requested By <br />Agency <br />Initizted From <br />Utility Locate (USA) No Called Date <br />Assic�nment Information <br />Dept <br />Crew <br />Contraclor <br />Assigned To <br />Assigned By <br />Assigned Date To Be Comp Date <br />Scheduled Dale _ Scheduled Time <br />Roule Route Sequence <br />Comments <br />Action Taken INSTALLED ON. METER #90602866. RF#1811854790. <br />Recommended Action <br />APpfOVE'd By HLJ HUSBY, LANCE J. <br />Start Date i � <br />Compleled By _ __ <br />Customer ld <br />Change Map Y/N <br />Zip <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Priority Estimated Hours <br />Job Costlnformation(YIN) <br />Time Date Completed tv2yio�� __ Permit No __ <br />Time Follow Up7 _ __ <br />y� <br />