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Order Number:SAP EC Notification Number: _ <br />| ' SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />1 Electric Corrective <br />HV 1 Work Form <br />yjfljla OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Facility:Damage:Action: <br />HAjv^iA" <br />'PRIORITY <br />D A - Emergency <br />D B - Urgent <br />nE-12Months <br />Q-FtfEG - Next insp <br />*Reporting Information: <br />'Identified in Field By: (PG&E = LAN ID)'Identified in Field On: O / 6? / f*f <br />'LAN ID MM DD YY <br />'Recommended Repair Date /^~ / 6' l_L^f__ 'E Crew Size <br />Work Type Code: <br />rewi "ize <br />DD YY <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 />Tot/ <br />'Circuit:'SSD:Pole # (Required if numbered Pole)Equipment #;Meter #: <br /><^ <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'Location #:'Street Address: <br />itx^C'C-^,. __i^ - ^ *^t/' <br />^^ — ^ <br />'Main Workcenter. <br />^ jto L C«_±Tt'v_ <br />Cross Street:'City: <br />Latitude/ Longitude: <br />3^ -0 c 3"??1 * <br />i . 5- j' y c> ( <br />"Identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply) <br />[^'Compliance Inspection D Trouble-Work CD 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'M <br />"Conductor Type (Required- Check One): <br />Q'Prirnary 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 -QTTemote (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 [S^Unknown Q-tffA/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 />I&.—^ <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