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�� <br />�ssucd oy cnc <br />Issued Deparimentrw <br />DB�C ISSU@d 11I2/2005 <br />Fund 4ot <br />Proc�ram <br />Work Activity Work Order <br />CRUM,GERRY <br />PUBLIC WORKS <br />E�,,,.� � <br />�i;..:�o;�� , <br />Accounl s Program ��o Funclion »s Activity e�a <br />T-dIC TAP 4IN 1930 75TH ST SE 710119fi73 <br />Work Order No 20051053 PfOJ0C1 Aclivily Type CORf2ECTIVE MAINTENANCE $�T�US pR <br />Date uni2oo5 Timen�:a4 Oripinal WO zoosio52 Billing <br />Customer Information <br />Customer Name <br />Address <br />�partment No <br />State <br />Subdivision <br />Phone No l 1 <br />Second Phone 1 1 <br />[-Mail Address <br />Problom Inlormation <br />�ddress 1930 <br />From Cross Street <br />To Cross Sireet <br />City <br />Subdivision <br />Problem <br />Sub Problem <br />Requested By <br />ngency <br />h�itiated From <br />Utility Locate (USA) No <br />Assignment Information <br />Dept <br />Q ew <br />Coniractor <br />Assigned To <br />Assigned k3y <br />Assigned Date <br />Scheduled �ate <br />Route <br />Commonts <br />Slreel <br />City <br />Zip <br />Ext <br />Ext <br />Streel 75TN ST SE <br />Map Book <br />Called Date <br />To f3e Comp Date <br />Scheduled Time <br />Roule Sequence <br />Customer ld <br />Chan�e Map Y/N <br />Zi� <br />Map Re(err,nce <br />Date Requesled <br />Rela�ed Requesl <br />Expiralion Dale <br />Priorily Eslimated Hours <br />ACtiOn T.^.kCn CONNECT TO EXISTING 4" WITH 8" TEE ANU 8 X 4 REDUCERS. <br />�,�y�, � // �� <br />Completed f3y ���"d �liJ� ���� � Ci7��L Job Cost Information(Y/N) � <br />Sl,�rt Datc � i Time Date Completed // �Z�� <br />Approved By Follow Up7 Permit No <br />Problem Datails <br />