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Wark Activity Work Order `"'" <br />�/2e/�r,t, :i�is <br />Issued By GCR GRENZNER, CHRIS R. <br />Issued Department Pw PUF3LIC WORKS <br />Date Issued 61312014 <br />Fund qo� Account 5 Program »o Function �2a A�tivity 673 <br />Program <br />TIfIB REPAIR 2009 21 ST ST 710123673 <br />Work Order No 20141323 Project Activiry Type CORRECTIVE MAINTENANCE SI8lU5 CL <br />Status s�3noia Time oe.00 Original W0 Billing _ ___, <br />Customer Information <br />Customer Name <br />Address Street <br />Apzrtment No City <br />State Z�P <br />Subdivision <br />Phone No 1 - Ext <br />Second Phone ) - Ext <br />E-Mail Address <br />Problem Information <br />Address yppg Street Z�ST ST <br />From Cross Street BROADWAY <br />To Cross Streel LOMBARD AVE <br />City EVERErT <br />Subdivision Map Book <br />Prablem DRAIN DRAINAGE <br />Sub Probiem DL DRAIN LINES <br />Requested By <br />Aaency <br />Initiated From PUBLIC PUBLIG <br />Utiliry Locale (USA) No 141J6930 Called Date <br />Assignment Information <br />Dept Pw PU�IIC WORKS <br />CfeW SCONST SEWER COIJSTRUCTION (OLHAVA) <br />Contractor <br />Assigned To IJM IMHOF, JAMES td <br />ASSign2d By GCR GRENZNER, CHRI; R. <br />Assigned Date To Be Comp Date __ <br />Scheduled Date Scheduled Time __._ <br />Route Route Sequence <br />Comments <br />Customer ld <br />Zip <br />Priority <br />Change Map Y/N <br />Mao Reference <br />Date Requested <br />Related Request <br />ExPiration Date <br />Estimated Hours <br />Action Taken REPLACED'!' OF 70" CLAY MAIN. TIED IN CB TO tOX10X6 VJYE. BACKFILLEU, COMPACTED <br />PREP FOR ASPHALT. <br />Recommended Action REPAIR DRAINLINE 8 SEWER MAIN <br />Approved By un� �MHOF, JAMES M JOb COSI If1fOfR12ilOf1(YIN) <br />Start Date � � Time Date Completed 61512D14 Permit No <br />