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Order Number:SAP EC Notification Number: <br />U^^U^^^^B <br />I Elect <br />Ww ° <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <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 <br />/ <br />Action: <br />'PRIORITY <br />D A - Emergency <br />a B - Urgent <br />DE 12 Months <br />Q-P-REG - Next insp <br />*Reporting Information: <br />'Identified in Field By: (PG&E = LAN ID)'Identified in Field On: _jQ / <br />'LAN ID <br />'Recommended Repair Date <br />MM DD YY <br /><r° I & f I ff <br />Work Type Code: <br />'E Crew Size <br />de: <br />'GC rewSize <br />MM DD YY <br />'Estimated Elec L abor Mrs: <br />Estimated Gas Labor Mrs: <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clercal if unknown in field) <br />' Plat Map:'Circuit:'SSD:Pole tf (Required if numbered Pole)Equipment #:Meter #: <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'Location #: <br />Z! <br />'Street Address:Cross Street: <br />h <br />*C/(y: <br />3 ^~~<3C*-i*^-v, <br />'Main Workcenter:Latitude / Longitude: <br />3 F t 0 6 <5"7>7 i a I - £]£ 9 H \ in Field During (Required - Check One): Secondary Field Identification (Check all that apply): <br />[^Compliance Inspection D Trouble-Work D Equipment Inspection D Joint 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 />"Conductor Type (Required - Check One): <br />D Secondary D Service D Service / Streetlight Conductor <br />ERR Pin (Reference Only) D PIN #: <br />OIS: (Required if Outage Related) D OIS#: <br />Field Condition - Exposure (Check all that apply - provide supporting comments if addition information is needed for field): <br />CH High Public Exposure OR Public Gathering Area (school, park, mall, etc,) D Commercial/Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area H-tfemote (Ag or Low Populated Area, etc.) D Waterway <br />Field Condition - Accessibility (Check all thai 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 _ _/ <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 />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 C3^0nknown 013TA/LTA D Flagging Required? d USA Required? <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 I <br />Version 1.6, Effective 6/26/2012