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Work Activity Work Order '� '� � <br /> ��ze�zois �s: :s <br /> ISSUBd By CSG CAVANAH,SHANE G. <br /> Issued Department aw PUBLIC WORKS <br /> Datelssued sneno�s <br /> Fund aot Account 5 Program �io FuncLon �i9 Achvity e�s <br /> Program <br /> TiIl2 RENEW JS MCH 203 47TH 5T SW 710119675 <br /> Work Order No 2��5�2�9 PfOfOC� Activity Type CORRECTIVE MAINTENANCE $�91US CL <br /> StaWs 5/2912C15 Time oe ia Original WO zo�aii�a Billing _ <br /> Customer Information <br /> Customer Name Customer ld <br /> Address Street <br /> Apartment No City <br /> State Z�P <br /> Subdivision Change Map Y/N <br /> Phone No f ) • Ext <br /> Second Phone ( 1 - Ext '— <br /> E-Mail Address <br /> Problem Information <br /> Address Street <br /> From Cross Street <br /> To Cross Street <br /> City 2ip <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 /> Crev✓ <br /> Contractor <br /> Assigned To <br /> Assigned By <br /> Assigned Date _ To 0e Comp Date __ <br /> Scheduled Date Scheduled Time _____ <br /> Route Raute Sequence <br /> Comments <br /> Action Taken RENEWED SERVICE OFF OF 12 INCH DI <br /> Recommended Action <br /> Approved By pe� FisHeR,soesv� Job Cost Information(Y/N) <br /> Start Date r i Time Date Completed 612I2015 Permit No <br /> Completed By Time Follow Up7 <br />