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Field Paving Form••Pacific Gas andI'1Ii1t~Electric Company <br />Date:t?I~/,'2JForemanName:_~A='tl.:::;ZIll-_ <br />PM Number:~111 "l""'~ <br />Street Address: <br />cr~Ci ICoun . <br />Permit Number: <br />Permit Expiration Date:_ <br />'5S?(p t1olZr!te.,-Bv~g::;:;ii l SJC <br />Concrete Wxl Depth <br />In Concrete:Y /N <br />Reflective:Y /N <br />Concrete 1Asphalt <br />f-_--lea <br />f-_--leaea 13"x 24"117"x 30"124"x 36"1---1ea 15"1 23"1---1ea 30'x 3D"132"x 32"I 4B"x 4B"L __ <br />Other W x l <br />Place Paver /Stone /Brick ~ <br />Traffic Marker Dots ea <br />Plug 1 Y,"Gas Prospect Hole ea <br />Adjust/Replace <br />Manhole Frame <br />Sidewaik Gas Valve Box <br />Secondary Electrical Box <br />Valve Frame <br />Valve Cover <br />Color:Y /N I Aggregate:YIN I Decorative/Stamped:YIN <br />Color:Y /N I Aggregate:YIN 1 Decorative/Stamped:Y /N <br />Color:Y /N I Aggregate:YIN 1 Decorative/Stamped:Y /N <br />Color:Y /N 1 Aggregate:Y /N 1 Decorative/Stamped:Y /N <br />Depth <br />~inches <br />inches <br />_inches <br />_inches <br />inches <br />_inches <br />_inches <br />Domes:Y)N <br />Gutter:YIN <br />If <br />a Size:#41 #5 <br />Wxl Depth <br />kinches <br />_inches <br />_"over <br />Inches <br />~If <br />C-jlf <br />Wxl <br />If <br />If <br />e <br />Seal <br />Roadway <br />Sidewalk <br />Sidewalk <br />Driveway <br />Driveway <br />Curb Ramp <br />Curb <br />Valley Gutter <br />Doweis <br />Asphalt <br />~MiiI &Fiil <br />Asphalt /Concrete Combo <br />Grind <br />Asphait Fabric <br />Asphait Berm /Curb <br />Saw Cut <br />rI <br />I <br />'I't}/iii <br />I ! <br />I~, <br />IIi <br />Notes <br />I------'-.----- <br />_inches <br />Inches <br />4"IB'112"Crosswalk <br />Width <br />ea <br />i <br />I <br />I <br />I <br />---~----,------I !i !: <br />I I I I I II!I I !i <br />I r !!I I I Ii;::;:~/I I,\i r i !,\~i ..?!Joll{n~I II I 'I"I --rlI'I I ~J,il'5,I I I II'I 'I I I \\11,I 'I I "I I <br />,I 11~~f~t~L\~~_:-!-~(--I--r <br />in:i,II I I Ii \:I : <br />i-J~-I-1'-1 -\-i --j--;-I-t-~---'J1,l'l '1---I , <br />'I i I! <br />, <br />f, <br />II\-- <br />II <br />I <br />.~--j, <br />Siurry /Fog I Sand <br />Striping <br />Paint <br />Thermoplastic <br />Traffic Legend <br />Double Center Lane <br />3M "Scotch Lane"