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Order Number:SAP EC Notification Number: <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />• 1 Elect <br />|V 1 <br />IliF&H O <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 />TRIORITY <br />DA- Emergency <br />D B - Urgent <br />C2 E- 12 Months <br />DF-REG-Nextlnsp <br />'Identified in Field By: (PG&E - LAN ID)«€1L U- <br />*LAN ID <br />'Identified in Field On: <br />'Recommended Repair Date <br />MM DD YY <br />Work <br />Size <br />Type Code: <br />3 'G Crew Size <br />DD YY <br />'Estimated Elec Labor Hrs: 5 <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 />Vo 700 <br />'Circuit: <br />36B- 1'fcp- <br />'SSD: <br />^P°n <br />Pole # (Required if numbered Pole)Equipment #: <br />1WDA?-TC?I> <br />Meter #: <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'Location #:'Street Address:Cross Street: <br />'Main Workcenler:Latitude/ Longitude: <br />-V H7 <br />identified in Field During (Required - Check One): Secondary Field Identification (Check all that apply) <br />LZl Compliance 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 Infrared (Check only if attaching IR Data Sheet) D SmartMeter!M <br />^Conductor Type (Required - Check One): <br />EH Primary 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 />E Residential Area EL Remote (Ag or Low Populated Area, etc.) D Waterway <br />Field Condition - Accessibility (Check alt 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 S No D Unknown DBTA/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): A/o^ /3~?~~*3 ~~r~y~ /?o / <br />G. x <br />Digital Picture #: <br />Bird Report Event Log ft: '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 byT-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