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Order Number:SAP EC Notification Number: <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />• 1 Electric Corrective <br />HV 1 Work Form <br />Jfef] OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form). <br />Facility:Damage:Action: <br />'PRIORITY <br />DA- Emergency <br />D B - Urgent <br />DE-12 Months <br />Q<REG - Next Insp <br />*Reporting Information: <br />'Identified in Field By: (PG&E - LAN ID) <br />'LAN ID <br />'Identified in Field On: <br />'Recommended Repair Date <br />MM DD YY <br />/// /ft, / <br />MM DD YY <br />Work Type Code: <br />'£ Crew Size rewl >ize <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clerical it unknown in field) <br />'Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />'PlatMap: <br />#£* <br />'Circuit: <br />30& • UbA <br />'SSD: <br />B<P^3 <br />Pole # (Required if numbered Pole)Equipment #: <br />£>3ct>oJ3£> <br />Meter #: <br />Location Information (*Location Number required for Compliance Inspection or Patrol) <br />'Location #: <br />37 <br />'Street Address:Cross Street: <br />4- <br />'City: <br />fh*±±^ <br />'Main Workcenter:Latitude / Longitude: <br />_3.i 7 /5 3 y <<I a \ 4 f 3 ^ * <br />"Identified in Field During (Required • Check One): <br />D^Compliance Inspection D Trouble-Work D Equipment Inspection "oin oe usomer ustaton &EQA Au <br />D Compliance Patrol D Crew-Work D Pole Test & Treat D Other D UWF (Urban Wildfire Area) D Work Verification D CPUC Audit <br />D Infrared (Check only if attaching IR Data Sheet) D SmartMeter <br />Secondary Field Identification (Check all that apply) <br />Q"tJoint Pole D Customer D Substation D PG&E/QA Audit <br />*Condyc(or Type (Required - Check One): <br />Q^Pnmary D Secondary D Service D Service / Streetlight Conductor <br />D Infrared (Check only if attaching IR Data Sheet) <br />ERR Pin (Reference Only) D PIN#: <br />OIS: (Required if Outage Related) d OIS#: <br />Field Condition - Exposure (Check all thai apply - provide supporting comments if addition information is needed for field): <br />D High Public Exposure OR Public Gathering Area (school, park, mall, etc.) D Commercial / Industrial Customer Q Extreme or High Fire Risk Area <br />D Residential Area D^Remote (Ag or Low Populated Area, etc.) D Waterway <br />Field Condition - Accessibility (Check all that apply - provide supporting comments if addition information is needed for field): <br />D No Road Access D Seasonal Work: (Dry, Harvest, Snow, etc.) Cannot Work From ^_/_ _ To _ _J_ <br />Q^rTaffic Control Plan Required MM / DD MM / DD <br />D Customer Issue (will not allow PG&E on property, etc.) D City Moratorium: Cannot Work From _ _ To <br />D CGI (Can't Get In): Dog, Locked Gate, Etc. MM / DD MM / DD <br />D Rear Easement D Special Circumstances: <br />'Is a Clearance required? D Yes d No D^Onknown QliTA/LTA D Flagging Required? DUSA Required? <br />*Field Comments (Describe the work required and the equipment and materials needed. For example: Special lools or equipment, any unusual conditions, <br />special circumstances, and supporting comments related to Exposure or Accessibility): <br />li U L^^.r^S <br />Digital Picture*: <br />Bird Report Event Log #:'Bird Incident No.: (Required for BGR/57R Raptor Work): <br />SECTION 2 - TO BE COMPLETED BY CREW PERSONNEL IF WORK IS COMPLETED IN FIELD (EMERGENCY OR SAME-DAY): <br />Completed By (LAN ID): <br />Signature: <br />/ verify that all mainten. <br />Completed bv T-Man? <br />mce on this notification is completed <br />Completed On: <br />MM <br />•Reviewed By: [ <br />, ,Actual Labor Hours: <br />DD YY <br />Compliance Department Review <br />'Reviewed On: 1 1 <br />Version 1.6, Effective 612612012