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Order Number.SAP EC Notification Number: <br />^SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />• 1 Electric C <br />|V 1 Work <br />HpCri OVER <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 />D E-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 />M <br />MM DD YY <br />U loll *' <br />MM DD YY <br />Type Code: <br />"G Crew Size'E Crew 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: <br /><AO <br />'Circuit: <br />^0^- \l <br />'SSD: <br />3*ic\e # (Required if numbered Pole) <br />Equipment #: <br />ibc^oskeei <br />Meter #: <br />Location Information {'Location Number required for Compliance Inspection or Patrol) <br />'Location #: <br />9 <br />'Street Address: <br />1W*~-T5*--X ^^ <br />'Main Workcenter: <br />^"Vbc-t^-k^ <br />Cross Street: <br />& 7*^x. <_c-«- — 4., r,, <br />'City: <br />^^v^LW^ <br />Latitude /Longitude: <br />'^1 7 I s '2 |1 / <br />3 i . 5-7 r 1 0 <br />identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply): <br />D^mpliance 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 Intuited (Check only it atiHdiiiKj IR Data Sheet) D SmartMeter'M <br />*Cond.uctor Type (Required - Check One): <br />ETPrimary 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.) D Commercial /Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area D-^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 / <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^Unknown Q-BTA/LTA d Flagging Required? QUSA 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 />< vy| "Ijf.^^ <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: <br />Version 1.6, Effective 6/26/2012