Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2020_PS-2001501 thru PS-2002000_ - PS-2001604

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Pacific Gas and Gas Service Record (GSR) FormTDationD-te:03/0/2019 Publication Date: 03/20/2019 In Electric Company If completing this farm W hand, use non -erasable blue or black ink. Effective Date: 05/20/2019 Map/Plat/Block: 3005-B4-42 Lot M Notif. #: 118910865 Address: 1538 N MORRISON ST City: STOCKTON PM Order #: 35178536 Leak#: Applicant/Tract Name: SANTOSARRELANO/209-817-3909 Est. LAN ID: JGHS Date Issued: 5/22/2020 Install Pipe: ❑No❑Yes Install Pipe: ❑No❑Yes ❑ New Phased Service Type: ❑PE2406/270B El Other: E Type: ❑PE2406/2708 El Other: El Stub F] Stub Completion CL g Performance/ Mfg: ❑Driscoplex ❑Other: it g Performance/ Mfg: ❑Driscoplex ❑Other: New Service: Mfg Date: Mfg Date: ® Full Service El Branch Service - Ref. # Replacement: Type: ❑Stub ®Other: COM PLETE SERVICE Type: El J Excavation Agent: ®PG&E ❑ Applicant J Excavation Agent: ❑ PG&E ❑ Applicant li ElFull Service F Installation Agent: ®PG&E El Applicant F Installation Agent: ❑PG&E El Applicant El Partial Service ❑Branch5ervice-Ref.# B • By: "' B • y o El Riser El Transfer (Person in charge LAN ID and signature or printedname") (Person in charge LAN ID and signature or printed name") Date: Date: ❑ Alteration ❑ Repair ❑ Soap Test ❑ Soap Test `. Tested by: Tested by: ❑ Deactivation (Qualified field rep. LAN IDand signature orprinted name') lQualiedfield rep. LAN IDand signature orprinted name') r r E] Uprate IF Date: F Date: Convert to: ❑ Main ❑ Service Pressure: psig Duration: min. Pressure: psig Duration: min. El Other xx Main: in. Status: ® None ❑ Existing ❑ Installed Reason None: LP SYSTEM Status: ® None ❑ Existing ❑ Installed ICE W o Installed Stub/Service: in. MatTE1Plastic El Metallic Flow Series: ❑400❑800❑Other: Mat'I:❑Plastic El Metallic a ru Size: ❑1/2"❑1"❑other: in. Size: ❑1/2"❑1"❑Other: in. s Existing Stub/Service: in. Mfg: ❑Elster-Perfection El Other: u Mfg: Status: ❑ None ❑ Existing ❑Installed Status: ❑ Existing ❑Installed Size1-1/4"X1-1/4'In. s Type: El Cathodic Protection Size: ®Locating Size: 410 H Outside Bypass: Location:® ❑ ® ❑ 3 Start: [XI Main ❑Branch El Other: Connection Method: [XI Bond ❑Strep/Wrap ae Type: ®Prefabricated ❑ Service Head Adapter ❑Steel End: ®Riser ❑Branch ❑Other: Connection Method: ❑Bond ®Strap/Wrap Riser Valve Mfg.: ❑lomar El Other: Isolated Steel Service (ISS): ® No ❑ Yes ❑ Existing CP Read Required: ® No ❑ Yes,: Weld Inspection Required: ❑ No ® Yes Anode:®No❑Existing ❑Installed Size: Ibs. N By I ? By (Qualified field rep. IAN ID and signature or printed name') (Qualified Beld rep. LAN ID and signature or printed name*) 12 � � — Type: ❑Zinc E] Magnesium #Installed: Pipe -to -Soil: mV Date: W Date: Location: ❑Riser ❑Valve El Service Reading Location: ❑Riser El Valve El Service 3 Type: ❑Radiographic El Visual El Mag. Particle 6 As -Built By: Contractor: Date: F (LAN ID) (Name and company name) As -Built By: Contractor: Date: (LAN ID) (Name and company name) PG&E IS TO TRENCH AND INSTALL 39' OF 1-1/4" PL LP SERVICE. S ENCROACHMENT PERMIT REQUIRED. z *If LAN ID is not available, write name and company name, include employee identifier if available. Draw sketch in space below. JOHN ST. P/L P/L w I I I da - J I � I N n'J I 1538 CD MORRISON AVE. CID 1I _1 /4 _PL W1 ----- —--------------- 1l --------1 1< 23' z CD � I O � I d I I o I w J J d d PG&E Internal 0 2019 Pacific Gas and Electric Company. All rights reserved.