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Work Activity Work Ordar <br />ISSUCd By LSG CAVANAH,SNANE G <br />Issued Department vw PUBLIC WORKS <br />Datelssued ensno�s <br />Fund aot Atcounis Program ��p Funchon >>g Adrvdy 6�5 <br />Progrem <br />Ti�le REPAIP ; S INC�1 t7+7 104T11 PL SW �t^"9675 <br />Wbrr Order No 20151905 P�o�ecl Act�wty Type coR�+Frr vr a�n�,vTt NnNc[ Slalus c� <br />Sialus e15�1o+s T�me �55a Or�g�nalWO B�ii��a <br />Customer Information <br />Gustomer Name <br />�dtlress Street <br />Apartment No City <br />State Z�p <br />Subdrvision <br />Phone No � � • Ext <br />Second Phone c Ext <br />E-Ma�l �.ddress <br />Problem Information <br />Address 1713 Street �04THPL SW <br />From Cross Stree[ <br />To Cross S!•eet <br />Ciry <br />Subdrviswn <br />Problem <br />Sub Problem <br />Requested By <br />A3ency <br />Indialed F ro�n <br />Ul�hty Locate (USA) Ro <br />Assignment �nlormation <br />Dep� <br />Cr?w <br />Cuntraclor <br />Assigned To <br />Assigned Hy <br />Assianed Oat� <br />Scheduled Da!e <br />Roule <br />Comments <br />Action Taken INSTALLCO SETiER WITII BO% <br />Map F3ook <br />Called Date <br />lo E3e Contp Datn <br />Schrdi,letl T�mF� <br />Rou'e Sequence <br />Custo^�er id <br />Change Map � N <br />1�P <br />Map Rere�e���e <br />Date �irq.�«��t.��f <br />Related Rem,r�;t <br />ExpiraUon Date <br />PrtOfl!y FShrn,dp�1 NU1.�', <br />Recommended Action <br />Approved By vel Fist�ER, BOeev � Job Cost Inlorrnation(Y/N I <br />- --.. <br />Start Date � � Time Date Completed e�as��ois Pe�rn�t No <br />Completed E3y T�me Follow Up^ <br />