Permits & Development - Encroachment(EP)/Driveway(DW) Permits -2020_PS-2003001 thru PS-2003500_- PS-2003496

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Pacific Gas and Gas Servlce Record (GSR) orml➢-95°nP5/2.2° Date:4'' Publication Date: 04/15/2°20 Electric Company If completing this form by hand, use non—erasable blue or black ink E(fedi2e Date: 07/15/2020 Lot J: N/A Notif. �: 118961305 PM Order : 35193411 Address 28069 S CHRISMAN RD City: TRACY Applicant/Tract Name: RICHARD POMBO / 209-914-2434 Est, IAN ID: FWf2 Date Issued: 9/9/2020 Leak (f: N/A Install Pipe: ❑No ❑Yes Install Pipe: ❑No El Yes El New Phased Service Type: ❑PE2406/27D8 El Other 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 XApplicant 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 or printed name' Date: 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. ❑1 in. LJOthec m. s Existing Stub/Service: in. Mfg: ❑Elster—Perfection El Other c'.o Critical Isolation Valve: El No El Yes El Unknown Status: ❑None ❑Exlst'Ing ❑Installed Status: E] Existing El Installed Size: 3/4 x 1 in. Type: ❑Cathodic Protection Size: XLocating Size: #10 Location: XDutside E] Inside Bypass: XNo El Yes 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. APPLICANT TO EXCAVATE IN PRIVATE, PG&E TO EXCAVATE IN FRANCHISE AND INSTALL 75' OF 1" PL HE SERVICE FROM EXISTING 3" STL HP MAIN. PG&E TD EXECUTE HOT TIE—IN. INSTALL (1) 1800 EFV, (1) 3/4" X 1" RISER AND (1) AC250 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. J J d i to I IP-- I o — 66' _ z IN PM}----------- 1r. PL ----------I IN � y I= 28069 � S CHRISMAN RD I _ I Led M ") I I eL I I 1= I Imo= an an X W I W RENA DR I J Cl PG&E Internal 0 2020 Pacific Gas and Electric Company. All rights reserved,