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Work Activity Work Order <br />Page 1 <br />155110d By yyMyy - — _ 5/25/2005 10:49 <br />Issued De artment Pw WARD, MICHAEL W, <br />P PUBLIC WORKS <br />Date Issued srzsnoos <br />Fund �ot Fund <br />Program Function Activiry 6 Program »o Func�ion �ta Activity e�a <br />TI�I@ REPAIR 4027 4TH ST SE 710719673 <br />WOfk OfdB� NO 20050537 PfOJBCI Activity Type CORRECTIVE MAINTENANCE SiBfUS pq <br />Date 3I25I2005 Time�o:zo Original W0 Biilin <br />_ 9 <br />Customer Intormaifon <br />Customer Name <br />Address <br />Apartme�t No <br />State <br />Subdivision <br />Phone No ( � _ <br />Second Phone ( � . <br />E-Mail Address <br />Probiem Information <br />Address 4027 <br />From Cross Street <br />To Cross Street <br />City <br />Subdivision <br />Problem <br />Sub Problem <br />Requested Eiy <br />Agency <br />Initiated From <br />Utility Locate (USA) No <br />Assignment Iniormation <br />Dept <br />Crew <br />Contractor <br />Assigned To <br />Assigned By <br />Assigned Date <br />Scheduled Date <br />Route <br />Comments <br />Action Taken „`eS! °�5�� <br />� e � <br />Street <br />City <br />Zip <br />Ext <br />Ext <br />Street 4TH STSE <br />Customer ld <br />Zip <br />Map Book <br />Cailed Date <br />Priority <br />To Be Cump Date <br />Scheduied Time <br />Route Sequence <br />Change Map Y!N <br />Map Reference <br />Date Requested <br />Related Request <br />Expiration Date <br />Estimated Hours <br />2 <br />RECORDS <br />�JUN 2 3 200� <br />