Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2020 - PS-2002501 thru PS-2003000_ - PS-2002699

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Pacific Gas and ce Record (GSR) orml➢-95°aP-14-4/15/ 20 Gas Servl0 Publication Date: 04/15/2020 Electric Company If completing this form by hand, use non—erasable blue or black ink Effective Date: 07/15/2020 Lot J: N/A Notif. �: 115101824 PM Order : 35181540 Address 18678 N HWY 99 City: ACAMPO Applicant/Tract Name: TOM ALEXANDER / 209-334-9112 Est, IAN ID: FWf2 Date Issued: 71212020 Leak )f: N/A Install Pipe: ❑No ❑Yes Install Pipe: ❑ND El Yes El New Phased Service Type: ❑PE2406/27D8 ❑ Other : E Type: ❑PE2406/270B El Other El Stub Mfg' F-] Performance/ Ce/ ❑Other: Mfg: ❑Peirforma Ce/ ❑Other: Completion s s New❑Servibe Mfg Date: Mfg Date: XFull Service ❑Branch Service Ref. Replacement: Type: ❑Stub XOther: COMPLETE SERVICE Type: ❑Com letion ❑Other: Excavation Agent: XPG&E El Applicant Installation Agent: XPG&E El Applicant n Excavation Agent: E: PG&E El Applicant Installation Agent: E: PG&E El Applicant ❑Full Service ❑Partial Service [:]Brunch Service - Ref. B By: B y' Person in charge LAN ID and signature or printed name' Person in charge LAN ID and signature or printed name' ❑ Riser Date, Date: ❑ Transfer ❑ Alteration E] Soap Test ❑ Soo p Test E] Repair Tested by: `" Tested by:❑Abandonment Qualified field rep. IAN IN and signature or printed Date: name' Qualified field rep. IAN IN and signature Date: or printed name' l W ❑Uprate Convert to: El Main El Service Pressure: psig Duration: min. Pressure: psig Duration, min. El Other: Main: in. Status: ❑None ❑Existing ❑Installed 1800 W. i Status, XNone El Existing El Installed Installed Stub/Service:-in. w Reason None: Flow Series: Mat'l ❑Plastic ❑Metallic Mfg: Nat'l: XPlastic ❑Metallic Size:❑Y n.XI in.❑Other: in. 82 Size, ❑Y in. ❑l in. LJOthec In. s Existing Stub/Service: in. Mfg: ❑Elster-Perfection El Other a'.o Critical Isolation Valve: El No El Yes El Unknown Status: ❑None ❑Exlst'Ing ❑Installed Status: E] Existing El Installed Size:l-1 4° x 1 Type: ❑Cathodic Protection Size: XLocating Size: #10 Location: XOutside E] Inside Bypass: ❑No XYes Start: XMain ❑Branch ❑Other: Connection Method: XBond ❑Strap/Wrap Type: XPrefabricated ❑Service Head Adapter El Steel End: XRlser ❑Branch ❑Other: Connection Method: ❑Bond XStrap/Wrap Riser Valve Mfg.: ❑Jamar ❑Other: Isolated Steel Service (ISS): XNo ❑Yes El Existing CP Read Required: XNo El Yes Weld Inspection Required: El No XYes Anode: XNo ❑Existing ❑Installed Size: Ibs. By: By: (Qualified field rep, LAN ID and signature or printed name') (Qualified field rep. IAN ID and signature or printed name') Type: El Zinc E] Magnesium ✓) Installed: Pipe -to -Soil: mV Date: Date: Location: El Riser ❑Valve ❑Service Reading Location: ❑Riser El Valve El Service Type: ❑Radlographic ❑Visual ❑Mag. Particle 12 As -Built By: Contractor: Date: Z (IAN I0 (Name and company name) As -Built By: Contractor: Date: (IAN ID) (Nome and company name) INSTALL NEW GAS SERVICE. PG&E TO PERFORM ALL EXCAVATION. PG&E TO INSTALL 75' OF 1" PL HE SERVICE FROM EXISTING 2" STL HP MAIN AND CONNECT SERVICE. INSTALL (1) 1800 EFV, (1) 1-1/4" x 1" RISER WITH 3/4" BYPASS AND (1) ALSOO METER. ENCROACHMENT PERMIT REQUIRED. 'It IAN ID is not available, write name and company name; Include employee Identifier if available. Draw sketch in space below. a E CLARKSDALE RD (45) P/L (T) HP HP HP HP HP (DE) EX. 2" ST H P — 10' P/L 497'—i— 25' I I I I a -i I NI z� I I I I I i I I 1 � On, la' I 18678 z N HWY 99 J � d J � C1_ PG&E Internal 0 2020 Pacific Gas and Electric Company. All rights reserved,