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Order Number:-SAP EC Notification Number: _ <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />I Elec <br />BBS < <br />Electric Corrective <br />Work Form <br />OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Facility:Action: <br />*PRIORITY <br />D A - Emergency <br />D B - Urgent <br />DE-12Months <br />- Next Insp <br />'identified in Field By: (PG&E -LAN ID)A n S r <br />*LAN ID <br />'Identified in Field On: <br />'Recommended Repair Date <br />Work Type Code: <br />.MM DD YY <br />\t ' 'E Crew Size <br />MM DD YY <br />rewi 'ize <br />Reference Information (Circuit & SSD Required at entry m to SAP - to be verified by Clerical if unknown in field) <br />'Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />'Plat Map: <br />\W <br />'Circuit: <br />\L£&^_\\_0\34^H <br />Pole # (Required if numbered Pole)Equipment #: <br />fOSLOS^ <br />Meter #: <br />] qo <br />Location Information ("Location Number required for Compliance Inspection or Patrol) <br />'Location #:'Street Address: <br />"Main Workcenter: <br />L^TT) C b~- i*"""4 <br />Cross Street: <br />-Ho ) IT* <br />'City: <br />Latitude / Longitude: <br />3 S ,O d 7L Qt \^LL_L£i^d_iJ <br />'Identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply) <br />LiXompliance Inspection D Trouble-Work D Equipment Inspection D Joint Pole D Customer Q Substation Q 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 !R Data Sheet) D SmartMeter™ <br />*Conduetor Type (Required - Check One): <br />ETprimary D Secondary D Service D Service / Streetlight Conductor <br />ERR Pin (Reference Only) D PIN#: <br />CIS: (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 />D High Public Exposure OR Public Gathering Area (school, park, mail, etc.) D Commercial / Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area Q^emote (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 ___/__ <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 j_ <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 LTUnknown 0"BTA/LTA D Flagging Required? D USA Required1? <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 Accessibiliiy): <br />if <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?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