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Order Nurnber:_SAP EC Notification Number: <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />1 Electric Corrective <br />MB 1 Work Form <br />IjTffen OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Facility:Damage:Action: <br />•PRIORITY <br />CD A -1 mcrgency <br />D B - Urgent <br />DE-12Months <br />OhTREG - Next Insp <br />*Reporting Information: <br />'Identified in Field By: (PG&E = LAN ID)'Identified in Field On:/e S I / fr <br />*LAN ID MM DU YY <br />'Recommended Repair Date " /. <br />MM DD YY <br />Work Type Code: <br />'E Crew Size <br />de: <br />'GC rew Size <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: 'Circuit: <br />(A& 3 ^P( - 1 1 D 1 <br />'SSD:Polo it (koquirort if niimbnrnd I'oln)Equipment*: Motor # <br />!OCiV-sCCo Pf&L, <br />Location Information ("Location Number required for Compliance Inspection or Patrol) <br />'Location /: 'Street Address:Cross Street:'City: <br />'Main Workcenter: <br />5wu*~~- 1 7 f i <br />Latitude / Longitude: <br />>0 * <br />o i <br />*uZHzI^C( IP <br />identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply): <br />[Huompliance Inspection n 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 />*Condvetor Type (Required • Check One): <br />H'Primary D Secondary D Service D Service / Streetlight Conductor <br />ERR P\n (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.) D Commercial / Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area QKemote (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 />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 Q'Gnknown Q^fA/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 0: '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 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