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Order Number:SAP EC Notification Number:B3 \N 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />BIB <Electric Corrective <br />Work Form <br />OVERHEAD <br />Facility: <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Damage:Action: <br />'PRIORITY <br />DA- Emergency <br />D B - Urgent <br />DE-12 Months <br />ST^REG - Next Insp <br />*Reporting Information: <br />'Identifiedin Field By: (PG&E = LAN ID)'Identified in Field On:I <br />*LANID <br />'Recommended Repair Date '' <br />DD YY <br />& -L l_l' <br />MM DD YY <br />/_J_2_ Work Type Code: <br />'E Crew Size rew*~ize <br />Reference Information (Circuit & SSD Required at entry in to SAP - to be verified by Clerical if unknown in field) <br />'Estimated Elec Labor Hrs: <br />Estimated Gas Labor Hrs: <br />'Plat Map:'Circuit: <br />£o°* - \\ \; <br />Pole # (Required if numbered Pole)Equipment #: <br />Icoc '<&Ab <br />Meter #: <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'Location*: 'St <br />17 <br />'eet Address: <br />1^^^,0/V -*— 3 \£\s^*A-<f <br />- — <br />-&*-r^S <br />Cross Street:'City: <br />J^^Y <br />'Main Workcenter: <br />fj*o bh-3 ?^2 <br />Latitude / Longitude: <br />7 ** /v 1 }v >£H23Z <br />identified 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 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 Q CPUC Audit <br />D Infrared (Check only if attaching IR Data Sheet) D SmartMeter™ <br />*Conductor Type (Required - Check One): <br />^Primary CH 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, mall etc.) D Commercial / Industrial Customer D Extreme or High Fire Risk Area <br />D Residential Area H"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 CD Special Circumstances: _^ <br />'Is a Clearance required? D Yes D No Q'Unknown 0BTA/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 />fit*L <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:I 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