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r <br /> Pacific Gas and <br /> Electric Company <br /> RettPaving Form [Per!dt Numbe.u� 1p <br /> _foe ___^ <br /> Date: —%—(`5 Street Address: 53 �! <br /> Foreman Name: -165 Cross Street: <br /> PM Number: 111OU105'L City/County; <br /> Concrete W x L Depth <br /> Roadway —inches <br /> Sidewalk inches Color Y/I+1 i Aggregate:P I N I DeoorativelStamped.Y I N <br /> Sidewalk _Inches Cdor Y/N I Aggregate:Y/N I DeooraUWJStamped:Y/N <br /> Driveway —Indies Color:Y/N I Aggregate:P I N I DemstiVelStamped:Y/N <br /> Dm f' <br /> —Inches Cdor.Y/N I Aggregate:Y/N I DeOM*'eJStamped:Y/N <br /> Curb Ramp Domes:Y IN <br /> Curb If Gutter:YIN <br /> Valley Gutter If <br /> Dowels ea Sae:#41#,5 <br /> Asphalt W x L Depth AdJttst/Replace <br /> Asphalt inches Manhole Frame <br /> ea <br /> Milt S Fill Inches <br /> Asphalt I Concrete Comboa <br /> o Sidewalk Gas Vahre Box <br /> _`over^ Secondary Electrical Box ea 13`x 2411 1T x 3tl'124'x V <br /> Grind _inches <br /> Asphalt Fabric Valve Frame ea <br /> Valve Cover ea 3tr x 3Q'132'x 32'148'x 48° _ — <br /> Asphalt Berm I Curb d <br /> Saw Cut Depth Oilier W x L <br /> Asphalt If inchesConcPlace Paves/Stand/Brick In Concrete:Y I N <br /> Seal to If _inches Traffic Marker Dols ea Reflective:Y i N <br /> Sea! W x L <br /> Slurry/Fog/Sand Ph Plug 1 W Gas ProspectFfoleLJOa Concrete alt <br /> C� I_ <br /> Stilping Width Notes <br /> Paint If —Inches ' <br /> Thermoplastic ff —inches <br /> Traffic Legend ea <br /> Double Center Leve y <br /> 3M`Scotch Lane N 4'18-1 IT Crosswalk <br /> die 220' <br />