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F. ,;. ! <br /> Service Request � ,;,,� , ,,, ,,,:� �, <br /> Request Information <br /> Request Nc 000��sas Date �i:alzoos Time os:3o Status PR <br /> Recorded By HSR �{OFFMAN,STEVEN R. <br /> Billing Code <br /> Customer Information <br /> Customer Name ROSENZWEIG,n� Custorner ld <br /> Address <br /> Apartment No City Zip <br /> Phone No ( ) Ext Second Phone ( ) Exl <br /> E-Mail Address <br /> Problem Information <br /> Addfess Streel 19TH AVE SE <br /> From Cross Street lo Cross Streel �t2rHsrsE <br /> Initiated From INiER INTERNAL <br /> City Subdivision <br /> Problem Details 14'ET ASPHALT 14 THE NORTH BOUND CURB LANE OF 19TH AVE SE JUST SOUTH OF 112TH <br /> Problem 1"�ATER WATER <br /> Sub Problem <br /> Down Dale Down Time <br /> Assignment Information <br /> Assigned To GTJ GALLAGHER,THOMAS J. <br /> Responded Dale Responded Time <br /> Left Date Left Time <br /> Work Order No. <br /> Action Taken <br /> Completed By: Date: � i <br /> Logged By <br />