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Order Number:SAP EC Notification Number: j_[_ <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />I Electric Corrective <br />Work Form <br />IjIffeFj OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Facility: <br />Pelt, <br />Action: <br />'PRIORITY <br />D A - Emergency <br />D B - Urgent <br />DE-12 Months <br />BT^REG - Next Insp <br />*Reporting Information: <br />'Identified in Field By: (PG&E - LAN ID)'Identified in Field On:// /' <br />'LAN ID MM DD YY <br />I '1 *T'Recommended Repair Date I s- IV' l__t <br />MM DD YY <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clerical if unknown in field) <br />Work Type Code: <br />'E Crew Size <br />de: <br />'GC rewSize <br />'Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />'Plat Ma:'Circuit:'SSD:Pole # (Required if numbered Pole) Equipment*Meter #: <br />Location Information {'Location Number required for Compliance Inspection or Patrol) <br />'Location /: <br />2s- <br />'Street Address:Cross Street:'City: <br />'Main Workcenter:Latitude/ Longitude: <br />I R:\ in Field During (Required - Check One): Secondary Field Identification (Check all that apply): <br />Q^Compliance Inspection D Trouble-Work D Equipment Inspection D Joint Pole D Customer D Substation O PG&E/QA Audit <br />D Compliance Patrol P 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 />*Comtocfor Type (Required- Check One): <br />L3Phmary 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 />D High Public Exposure OR Public Gathering Area (school, park, mall, etc.) DICorrunercial / Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area ^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 / <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 CnJnknown ETBTA/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 />/*' - j <br />Digital Pictured: <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: <br />Version 1.6, Effective 6/26/2012