Permits & Development - Encroachment(EP)/Driveway(DW) Permits-2020_PS-2003501 thru PS-2004000_-PS-2003575

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IM Pacific Gas and Gas Service Record (GSR) Form ro—ebanP—w-Em,Rev. 2h Publication Date oa/td72a2a Electric Company H completing thison�msahle ls foan by hood, use nblue or block Ink Effective Dade. 0l Lot #: Nctlf. #: 119187335 PM Order #: 35185015 Address: 7707 S ASH ST City; FRENCH CAMP Applicant/Tract Name: ANTONIO NOCETI / 209-482-6969 Est. LAN ID: JGH5 Date Issued: 7/16/2C Leak #: Install Pipe: ❑No El Yes Install Pipe: ❑No El Yes El New Phased Service Type: ❑ PE2406/2708 ❑ Other: w Type: ❑ PE2406/2708 ❑ Other: ❑ Stub Mfg' ❑Deis omance/ ❑ Other : mfg. ❑plex Prise mance/ ❑Other: Stub s s eCompletion Ne❑ Mfg Date: Mfg Date: ®Full Service ❑Branch Service —Ref. # Type: ❑Stub ®Other: COMPLETE SERVICE Type: ❑Com Ietion El Replacement: Excavation Agent: El PG&E ®Applicant Installation Agent: El ®Applicant r Excavation Agent: El PG&E El Applicant Installation Agent: El El Applicant w El Full Service El Partial Service PG&E PG&E mo ❑Branch Service — Ref. # A R A R Person in charge A ID and signature or printed name° Person in charge A ID and signature orprinted name° ❑ Riser Date: Date: ❑ Transfer El Alteration ❑Soap Test ❑Soap Test E] Repair Tested by: " Tested by: Abandonment Qualified field rep IAN ID and signature or printed name') Date: -----------------El Qualified field rep IAN ID and signature or printed Date: name° N ElDprate Convert to: ❑Main ❑Service Pressure: psig Duration: min. Pressure: psig Duration: min. I I El Other: Main: in. Status: El ❑Existing ❑Installed w, Status: ®None El Existing El Installed Installed Stub/Service: In. e �i Reason Nine: Flow Series: 800 Mat'I: ❑Plastic ❑Metallic Mfg: Matt: ®Plastic ❑Metallic Size: ❑Y In. [Al in. ❑Other in. Size: ❑Y in. El in. ❑Other in. Existing Stu S/ In. Mfg: ❑Elster—Perfection El Other: v Critical Isolation Valve: El No El Yes El Unknown Status: El None El Existing El Installed Status: E] Existing El Installed Size: 1 X 3/4 In. Type: ❑Cathodic Protection Size: ®Locating Size: 10 Location: ®Outside El Inside Bypass: ®No El Yes Start: ®Main El Branch ❑Other. Connection Method: ®Band ❑Strap/Wrap Type: ®Prefabricated E] Service Head Adapter El Steel End: ®Riser El Branch ❑Other. Connection Method: El Bond ®Strap/Wrap Riser Velve Mfg.: ❑Jomar El Other: Isolated Steel Service (ISS): ®No El Yes El Existing CP Read Required: ®No El Yes Weld Inspection Required: El No ®Yes Anode: ®No ❑Existing El Installed Size: _Ibbs. By: = By: (Qualified field rep. NN ID and signature or printed namea) (Qualified field rep. IAN IN and signature or primed name*) — Type: El Zinc El Magnesium # Installed: Pipe—ti—Soil: mV Date: Date: Location: El Riser El Valve El Service Reading Location: El Riser El Valve El Service Type: El Radiographic El Visual ❑Mag. Particle As—Built By: Contractor: Date: (IAN ID) (Nome and company name) $ As—Built By: Contractor: Date: (IAN ID) (Name and company name) APPLICANT TO TRENCH AND INSTALL (88') OF 1" PL HP SERVICE, 800 EFV AND 3/4" RISER. ENCROACHMENT PERMIT REQUIRED BY APPLICANT. PG&E TO INSPECT AND TIE—IN °If LAN ID is not available, write name and company name; Include employee Identifier it available. Draw sketch in space below. J J O_ d H _ o I 00 I— w x I W d cn J � I N 7707 S. x w ASH ST. IN ST. 1" PL 63 P5' N I ASH ST.80'L_ I d x P/L -- -- I I w 0 J d PG&E Internal 02020 Pacific Gas and Electric Company. All rights reserved.