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9 Electric Company <br /> FIELl` Piiii�v ic,� URE��E ~� rpt <br /> 117ak- <br /> Circle One General Construction Division Pave7rak T ag ft <br /> Completion and submission of this form implies approval of job(s)fisted below and authorization to process this request for service. <br /> Supervisor Permission to Release: Purchase Order# <br /> Date issued to Contractor: Date Contractor completed work: <br /> Job Address/Location: Cn r <br /> t <br /> city/county: <br /> Date Foreman: <br /> r'hone <br /> PM#or S 101 <br /> ORDER t# dC' Q(29 C� TSM# Date <br /> inspected: <br /> Permit ft I <br /> Exp. Dale Inspected by: <br /> I YPC OF PAVING rM Asphalt ❑ Concrete ❑ Sidewalk ❑ Other <br /> PRIORITY ❑ High ( Normal <br /> ❑ Complaint ❑ If applicable,completion date; <br /> DESCRIPTION SIZE <br /> PG&E CONTRACTOR DEPTH <br /> PG&E CONTRACTOR <br /> SA 3--Patch / It <br /> (T-qut GleasuremenG on each) <br /> SA 23—Saw Cut <br /> SA 29—Sand Seal <br /> Provide details as necessary-sfreet names, location address,safety information, and patch measurements. <br /> Sketch orjob instructions... n <br /> A. <br /> cD o <br /> N0 <br /> E <br /> L14 <br /> N�� o <br /> �F Irl I cu <br /> S/CMOfr&D/Paving Tag Rev 41/21/04.doc <br /> AOC; ,76 je.1 <br />