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Fage 1 <br />Work Activity Work Order B,ls,Zoll 1.,:,1 <br />ISSUEd By CSG C.4VANAH,SHANE G. <br />Issued DepartmentPw Pl1BLICWORKS <br />Date Issued s�ei2o�t Account s Program 7�o Function »9 Activity srs <br />Fund ao� <br />Program <br />Title RENEW .751NCH 4032 RUCK[R AVE 77 07 7 5675 <br />WOfk Ofdef NO 20110680 PfOjCC[ Activiry Type CORRECTIVE IdAINTENANCE SfBfUS CL <br />Status / ]� �. Billin9—_-- ---- – – <br />sie�2oi � Time oase Original WO Zd lC%_ _� ---- <br />Customer Information <br />Customer Name <br />Address <br />ApartmentNo <br />State <br />Subdivision <br />Phone No � > - <br />Second Phone ( � • <br />E-Mail Address <br />Problem Information <br />Address <br />Fram Cross Street <br />To Cross Street <br />City <br />Subdivision <br />Probl2m <br />Sub Problem <br />Requested Ry <br />Agency <br />Initiated from <br />Utility Locate (USA) �o <br />Assignment Information <br />Dept <br />Crew <br />Contractor <br />Assigned To <br />Assigned By <br />AssignedDate _ ___ __ <br />Scheduled Dale ______. <br />Route <br />Comments <br />Street <br />City <br />Zip <br />Ext <br />Ext <br />Street <br />Map Book <br />Called Date <br />To Be Comp Date <br />Scheduied Tiine <br />Ro�te Sequence <br />Customer ld <br />Change Map YIN <br />Zip <br />Map Reterence <br />Date Requested <br />Related Request <br />Expiration Date <br />Proriry <br />Estimated Hours_ . <br />��'.�'l.l.� �t� �J <br />AUG 2 5 2�11, <br />Action Taken CONNECTED TO NEW 8" MAIN AND INSTALLED 12" SETTER 8 BOX. <br />Recommended Action <br />Approved By BGM2 OL=UK[RS, GHORGE M. <br />Job Cosllnformation(YIN) <br />Start Date � i Time _ Date Comp!eled eiv=o�� _ Permit No ___ <br />— Time _ ___ Follow Up? <br />Completed By _ _ _---- _ — — — - <br />