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Order Number:SAP EC Notification Number: <br />^SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />Rl <br />Electric Corrective <br />Work Form <br />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 />- Next Insp <br />^Reporting Information: <br />'Identifiedin Field By: (PG&E = LAN ID) <br />'LAN ID <br />"Identified in Field On: <br />'Recommended Repair Date <br />MM DD YY <br />Work <br />Size <br />Type Code: <br />*G Crew Size <br />MM DD YY <br />"Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clerical if unknown in field) <br />'Plat Map: <br />fie/te <br />'Circuit: <br />io:x <br />•SSD: <br />17 <br />Pole # (Required if numbered Pole)Equipment #: <br />)t>9i<•fc i-* <br />\fi.£t, <br />Meter #: <br />B <br />Location Information fLocation Number required for Compliance Inspection or Patrol) <br />'Location #:'Street Address: <br />'Main Workcenter: <br />0 6* 99 <br />2 Y <br />Fr to f <br />1 <br />l*h^ <br />7 r <br />\~Vv <br />Cross Street; <br />*%^ <br />Latitude / Longitude: <br />3 i I JL L ,1 £ ( / <? <br />"Identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply): <br />B^ompliance Inspection D Trouble-Work D Equipment Inspection @""Jomt Pole D Customer D Substation D PG&E/QA Audit <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 />ERR Pin (Reference Only] D PIN #: <br />OIS: (Required if Outage Related) D OIS #: <br />Type (Required - Check One): <br />nimary D Secondary D Service D Service / Streetlight Conductor <br />Field Condition - Exposure (Check all that 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 D Extreme or High Fire Risk Area <br />GKResidential 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 />L^No^Road Access D Seasonal Work: (Dry, Harvest, Snow, etc.) Cannot Work From / _ To _ _/_ <br />D Traffic 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 />MM/ DD <br />D Special Circumstances: _ <br />A Q Flagging Required? DUSA Required? <br />MM/ DDD CGI (Can't Get In): Dog, Locked Gate, Etc. <br />QT^ear Easement <br />'Is a Clearance required? D Yes D No Q^tTnknown <br />*Field Comments (Describe the work required and the equipment and materials needed. For example: Special tools or equipment, any unusual conditions, <br />special circumstances, and supporting comments related to Exposure or Accessibility): <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 />Completed by T-Man? I I Completed On:Actual Labor Hours: <br />/ verify that all maintenance on this notification is completed 'Reviewed By: <br />DD YY <br />Compliance Department Review <br />'Reviewed On:I <br />Version 1.6, Effective 6/26/2012