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►�� Pac <br /> ific Gas <br /> ompany Field Paving Form <br /> Permit Number: <br /> Permit Fxpiratfon DW,le: <br /> Date: Street Address: /)'4•GV <br /> Foreman Name: Yr Cross Street: 1,✓/1 <br /> PM Number: 1. 6O City/County: <br /> Concrete W x L Depth <br /> Roadway _.Inches <br /> Sidewalk —Inches •Color.Y/hi{Aggregate:YIN I DworativelSlamped:Y/N <br /> Sidewalk —inches Color.Y/N j aggregate:Y/N { Decorafive)Sfamped:Y/N <br /> Driveway —I"es Color.Y/N j aggregate:Y!N { DecorativeJStamped:Y/N <br /> Driveway —inches Color.Y/N I Aggregate-.YIN j Decorative/Sfamped:Y/N <br /> Curb Ramp Domes:Y!N <br /> Curb ff Gutter.Y/N <br /> Valley Gutter tf <br /> Dowels " ea Slze:#4195 <br /> Asphalt W x L Depth Adjust/Replace <br /> Asphalt I—fnches Manhole Frame _ I ea . <br /> Mill&Fill ,Indies Sidewalk Gas Valve Box ea <br /> Asphalt/Concrete Combo `over Secondary Electrical Box ea 13'x 24'{irx 30'(24'x36' <br /> Grind Inches Valve Frame ea 15' 23' <br /> Asphalt Fabric Valve Cover ea 30'x N 132'x 32'.148'x 48' <br /> Asphalt Berm/Curb ff <br /> Saw Cut Depth Other W x L <br /> Asphalt If —inches Place Paver/Stone/Brick In Concrete:Y/N <br /> Concrete If ____inches Traffic Marker tots ea Retieoft Y!N <br /> Seal W x L Aug i K Gas Prospect Hole Mea Concrete{Asphaft <br /> Slurry/Fog/Sand <br /> Striping Width Notes <br /> Paint ff _itches <br /> T hermoplastic If hares <br /> Traffic Legend ea <br /> Double Center Lane ff <br /> 3M'Scotch Lene' If 4'I fr{12'Crosswalk <br /> - r✓L <br />