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Order dumber:SAP EC Notification Number:\t>°t°t <br />SECTION 1 - TO BE COMPLETED BY FIELD PERSONNEL <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: <br />. £. <br />Action: <br />'PRIORITY <br />D A Emergency <br />D B Urgent <br />DE 12 Months <br />Next Inspect <br />*Reporting Information: <br />'Identified in Field By: (PG&E = LAN ID)'Identified in Field On: 0 I I 1C /_J <br />'LAN ID MM DD YY <br />'Recommended Repair Date ® t_ /__/y_ /_.__ <br />Work Type Code: <br />*E Crew Size ewS ze <br />MM DD YY <br />"Estimated Elec Labor Hrs: <br />Reference Information (Circuit & SSD Required at entry in to SAP-to be vgrifi_e_d__by_CJencai if unknown in field) <br />Estimated Gas Labor Hrs: <br />"Plat Map: <br /><X /3>-r <br />'Circuit3&-I' n&i *SSD: <br />OI3**3 <br />Pole # (Required if numbered Pole)Equipment #: <br />lD£VDr>7^ <br />Meter #: <br />' <br />Location Information ('Location Number required for Compliance Inspection or Patrol) <br />'Location #:*Street Address:Cross Street: <br />ljA**X^eA — <br />*C;fy: <br />'Main Workcenter: <br />$)^cb-)~*-~ <br />Latitude /Longitude: <br />V 7 r? o -i \ <br />— * * t if &**~ *c ^1 - C (, 1 \ <br />*ldenfified in Field During (Required - Check One): <br />& Compliance Inspection D Trouble-Work D Equipment Inspection <br />D Compliance Patrol D Crew-Work D Pole Tests Treat D Other <br />P Supervisor Work Verification fj PS&R Work Verification <br />"CopdGctor Type (Required - Check One): <br />LJ Primary D Secondary C Service D Service / Streetlight Conductor <br />Secondary Field Identification (Check all that apply): <br />ET^Joint Pole D Customer D Substation D PGSE/QA Audit <br />D UWF (Urban Wildfire Area) D SmartMeter™ Q CPUC Audit <br />fj Infrared (Check oniy if attaching IR Data Sheet) <br />L~H IDLE (Check if IDLE facility has other maintenance FDA) <br />COE Pin (Reference Only) HI 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 D^Remote (Ag or Low Populated Area, etc.) D Waterway <br />To <br />i DD <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 / <br />D Traffic Control Plan Required 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 />*ls a Clearance required? D Yes D No EMjnknown / 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 />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):Completed On:*Actual Labor Hours: <br />'Crew Type: D Div D GC D PS&R Inspector D T-Man D Contractor <br />'Signature: <br />/ verify that all maintenance on this notification is completed *Reviewed By: <br />MM DD YY <br />Compliance Department Review <br />^Reviewed On: