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NO MATERIqLS <br /> Work Activity Work Order page 1 <br /> 12/28/2011 6:99 <br /> ISSUed By AGA AHLES,GREGORY A. <br /> Issued Department vw PUBLIC WORKS <br /> Date Issued 9�ZZ1Z��� <br /> Fund aot Account s Program no Function tz3 Activity 673 <br /> Program <br /> Title REPAIR 4974 23RD AVE W 710123673 <br /> Work Order No 20112317 Project Activiry Type SERVICE REQUEST Status a <br /> Status __ 9�lliZoti Time oe:ae Original WO ooiot�9t _____ Billing __ __ <br /> Customer Infortnation Customer ld <br /> Customer Name <br /> Address 4914 S�fBB1 23RD AVE W <br /> Apartment No City <br /> State Z�P <br /> Subdivision Change Map YIN <br /> Phone No ( � - txt __ _ <br /> Second Phone ( ) - Ext <br /> E-Mail Address -- ---- <br /> Problem Information <br /> Address 4914 Street y3RD AVE W <br /> From Cross Street <br /> To Cross Street <br /> City Zip <br /> Subdivision Map Buok Map Reference <br /> Problem DRAIN DRAINAGE <br /> Sub Problem DL DRAIN LINES <br /> Requested By Date Requested <br /> Agency Related Request oo�one� <br /> Initiated From <br /> Utility Locate (USA) No Called Date Expiration Date <br /> Assignment Information <br /> Dept PW PUBLIC WORKS Priority Estimated Hours <br /> Cf2W SCONST SEWER CONSTRUCT�ON(AHLES) <br /> Contrector <br /> Assigned To ��M IMHOF,JAMES M. <br /> Assigned By A�A AHLES,GREGORY A. <br /> Assigned Date ___._ To Be Comp Date ___ <br /> Scheduled Date ______ Scheduled Time __ <br /> Route Route Sequence <br /> Comments <br /> Action Taken REMOVED DAMAGED PIPE.INSTALLED 32 FEET OF 121NCH HANCOR PIPE.BEDDED IN <br /> GRAVEL. <br /> ROCOfT1fIlBfldBfJ ACt1011 RECONNECT PRAIN LINE AND BACK FILL ANY WASH OUT <br /> AppfOVed By IJM IMHOF,JAMES M. JOb COSi IflfOfrtl2ilOf1(YIN) <br /> Start Date � � Time Date Completed 9l3012011 Permit No _ <br /> Completed By Time Follow Up? <br /> �3 <br />