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Orrfpr Nifnber:SAP EC Notification Number: <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <br />I Elec <br />" ' <br />Electric Corrective <br />Work Form <br />OVERHEAD <br />*FDA Description <br />(Enter highest priority Facility/Damage/Action from back of Form): <br />Plity:Damage:Action: <br />'PRIORITY <br />DA - Emergency <br />D B - Urgent <br />nE^I 2 Months <br />LTF"REG - Next Insp <br />"Reporting Information: <br />•Identified in Field By: (PG&E = LAN ID)'Identified in Field On: <br />•LAN ID MM DD YY <br />'Recommended Repair Date U lOt I *7 <br />Work Type Code: <br />'E Crew Size rew^tize <br />MM UD 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 M3p: <br />&t>H <br />'Circuit: <br />I6^0°i- Moi <br />'SSD: <br />^\16 <br />Pole # (Required if numbered Pole)Equipment 1: <br />IO3G533G <br />Meter #: <br />D <br />Location Information ("Location Number required for Compliance Inspection or Patrol) <br />'Location #: <br />1 <br />'Street Address: <br />/ n 1 _0 c' J3 A *T"~< i / P,$ <br />'Main Workcenter: <br />Cross Street: <br />£OH*JO--TWi <br />'CV/y; <br />Latitude / Longitude: <br />3 1 f 9 <br />* <br />>3 3 1 \) . r ? j s- \ in Field During (Required - Check One): <br />0"Compliance Inspection D Trouble-Work D Equipment Inspection <br />D compliance I'atioi D Crew-Work U Pole Test & Treat D Other <br />"Conductor Type (Required- Check One): <br />D Secondary D Service D Service / Streetlight Conductor <br />Secondary Field Identification (Check all that apply): <br />D Joint Pole D Customer D Substation D PG&E/QA Audit <br />D UWF (Urban Wildfire Area) D Work Verification D CPUC Audit <br />D Infrared (Check only if attaching IR Data Sheet) D SmartMeter™ <br />ERR Pin (Reference Only) Q PIN #: <br />OIS: (Required it Outage Related) D OlS #: <br />Field Condition - Exposure (Check all that apply - provide supporting comments il 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 Ptan Required MM / DD MM / DD <br />D Customer Issue (will not allow PG&E on property, etc.) D City Moratorium: Cannot Work From I To _ _/_ <br />CH 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^Tjnknown EToTA/LTA Q 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 #: *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 />MM <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