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� <br /> Work Activity Work rJrde�r <br /> ISSUCd By CSG CAVANAN,SHANE G. <br /> ISSued Department PW PUOLIC WORKS <br /> Date Issued to�2s�zoo9 <br /> Fund ao� Account s Frogram �to Function >>y Acliviry e�s <br /> Program <br /> l Ille RENEW.751NCH 310 42N�ST SW 710119675 <br /> W�, k Ortler No 20092961 Projecl Aclivity Type coi�itecnve �er,r.lehnNCE StaWs c� <br /> SlaWs toizc2oo3 Time t2:si Original WO 2ooszo7� Billing <br /> Customer Information <br /> Cuslomer Name Customer ld <br /> Address Strea� <br /> Aparlmenl No City <br /> State Zip <br /> Subdivision Change t�.1ap Y/M <br /> Phone No ( I • Ext <br /> Second Phone ( ) - Ezt <br /> GMail Address <br /> Problem Information <br /> Address 3�p SUeel q pNu S7 SW <br /> From Cross Streel <br /> To Cross Street <br /> City Lip <br /> Subdivision Map Book Map Reference <br /> Problem <br /> Sub Problem <br /> Reyuested By Date Requested <br /> Agency Related Reque•.t <br /> Inilialed Prom <br /> Utiliry Locale (USA) No Called Date Expiration Dale <br /> Assignment �nformatian <br /> Dept Friorily Eslimated Hours <br /> Crew <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date io Be Com,r, Date <br /> Scheduled Dale Scheduied Time <br /> Route Route Sequence <br /> Commenis <br /> Action Taken coNNecrru ro rttv raniri <br /> Recommended Action <br /> Approved By eGMz �i�-����-� "ti-�'��<�r,�;[=. t,� Job Coet Inform�tion(Y/N) <br /> Slart D.�l�� � Tinic Date Coinpleled �v2gnooe Permlt No <br /> t�oin{4uba1 !3; Time Fallow Up? <br />��A �h � t =5��. . �:�=_.FCVa . . '7 .``E�[, y <br /> . ... ,�� n � V'4 . . <br /> s� <br /> r �r, <br /> ,:r� ''!�M � <br />-_ __-i-_ -_�u 5`� �♦ � �.4 . � <br />