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Vl/ork Activity Work Order <br />ISSU2d By CSG CAVANAH, SHAHE G. <br />Issued DepartmentPw PUBLICWORKS <br />Date Issued 9mzots <br />Fund aoi Accounl s Program »o <br />Program <br />TitIB CONVERT 75 INCH 75C6 7TH DR W 710179675 <br />Function ��y <br />Pa�� � <br />ii�zn�zois io::c, <br />Activity 6�5 <br />Work Order No 20151968 Project Activiry Type CORRECTIVE 61ilINTENANCE <br />Slatus erzno�s Time 1G05 OriginalWO Ei;lling <br />Customer Information <br />Customer Name <br />Address Street <br />Apartment No City <br />State Zip <br />Subdivision <br />Phone No ( 1 - Ext <br />Second Phone ( � - Ext <br />E-Mail Address <br />Problem Information <br />Address 7506 Street 7TH DR W <br />From Cross Street <br />To Cross Sireet <br />City <br />Subdivision Map Book <br />Problem <br />Sub Problem <br />Requested By <br />Agency <br />Initiated From <br />Ulility Locate (USA) No Called Date <br />Assignment Informa[ion <br />Dept Prionry <br />Crew <br />Contractor <br />Assigned To <br />Assigned By <br />Assigned Date To Be Comp Date <br />Customer ld <br />Chance Map Y/N <br />Zip <br />Map Reference <br />Scheduled Date Scheduled Time <br />Route Route Sequence <br />Comments <br />Action Taken CONVERTEO TO INETER MEASUREME.ITS PER GO SYNC. <br />Date Requested <br />Related Request <br />Expira[ion Date <br />[stimated Hours <br />StBWS CL <br />Recommended Action <br />ApPfOVed By BRP BIGLEY, RYAN P. JOb COSI If1fOfR1BlI0f1(Y/N)_ _ <br />Start Date � i Time Date Completed sn5i�e�s Permit No <br />_ _ — -- -- — - <br />Completed By Time Foliow Up7 <br />