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Work Activity Work Order Pa9e 1 <br /> iz�ze�zoii is:ze <br /> ISSUed�By NSO NIELSEN,SCOTT 0. <br /> Issued Department Pw PUBLIC WORKS <br /> Date Issued 5n��zo» <br /> Fund aot Account s Program »o Function tta Activity s�5 <br /> Progrem <br /> TIIIQ REPAIR.75 1NCH 7228 SKIPLY RD 710710675 <br /> WOlk Ofd2f NO Z���D�9Z PfOJBC1 ACtlVihl TyPB CORRECTIVE MAINTENANCE St8�U5 CL <br /> Status einizoii Time >>:ss__Original WO_ _ _ Billing________ _ _._ <br /> Customer Information <br /> Customer Name Customer d <br /> Address Street <br /> Apartmenl No ��ty <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> PhoneNo ( ) - Ext ------- -- ---- <br /> Second Phone ( ) - Ext <br /> E-Mail Address —_ -__ --— <br /> Problem Information <br /> Address Street <br /> From Cross Street <br /> To Crass Street <br /> City ZiP <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Requested By Date Requested <br /> Agency Related Request <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 8y <br /> Assigned Date _ ____ To Be Comp Date _ <br /> Scheduled Date _ _ Scheduled Time <br /> Raute Route Sequence <br /> Comments <br /> Action Taken REPLACED VALVE BOXES <br /> Recommended Action <br /> Approved By Nso Nie�seN,scorr o. Job Cost Infcrmation(YIN) <br /> Start Date � I Time _ Date Completed snei2o�t_ Permit No <br /> Completed 8y _ Time Follow Up7__ <br /> `l <br /> z <br />