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MPacific Gas and Field Paving Form <br />Electric Company <br />• • - r - - - <br />® <br />® <br />Street Address: .Idle T 7ed,e <br />Date: <br />Foreman Name: <br />®. <br />Cross Street: <br />_® S <br />PM Number: q.3 <br />1 -7A Q <br />b <br />Ci oun ' TOS ®iI I <br />Concrete <br />W x L <br />Depth <br />Roadway <br />_inches <br />Sidewalk <br />_ inches <br />Color: Y I N Aggregate: Y/ N I Decorative/Stamped: Y I N <br />Sidewalk <br />_ inches <br />Color:.Y I N Aggregate: Y 1 N I Decorative/Stamped: Y I N <br />Driveway <br />_ inches <br />Color: Y/ N Aggregate: Y I N Decorative/Stamped: Y I N <br />inches <br />Color: Y I N Aggregate: Y I N Decorative/Stamped: Y I N <br />Driveway <br />N <br />_ <br />Curb Ramp <br />Domes: Y 1 N <br />Curb <br />If <br />Gutter: Y I N <br />Valley Gutter <br />If <br />Dowels <br />as <br />Size: 941 #5 <br />Asphalt <br />W x L <br />Depth <br />AdjustlReplace <br />AEill <br />3® r <br />�rinches <br />Manhole Frame <br />ea <br />_ inches <br />Sidewalk Gas Valve Boxea <br />Asphalt 1 Concrete Combo <br />_" over <br />Secondary Electrical BoxHea <br />ea 13" x 24" 17" x 30" 24" x 36" <br />Grind <br />_inches <br />Valve Frame <br />ea 15" 23" <br />Asphalt Fabric <br />Valve Cover <br />30" x 30" 132" x 32" 148" x 48" <br />Asphalt Berm 1 Curb <br />If <br />Saw Cut <br />Depth <br />Other W x L <br />r <br />(f;;:)1 63rX'yr <br />If <br />ar <br />% inches <br />Place Paver /Stone 1 Brick <br />In Concrete: Y I N <br />Concrete <br />�if <br />— inches <br />Traffic Marker Dots <br />Ilea <br />Reflective: Y / N <br />Seal <br />W z L <br />Plug 1 % Gas Prospect Hole <br />ea Concrete Asphalt <br />Slurry 1 Fog 1 Sand <br />m <br />Striping <br />Width <br />Notes <br />Paint <br />If <br />_inches <br />Thermoplastic <br />If <br />_Inches <br />Traffic Legend <br />ea <br />Double Center Lane <br />If <br />3M "Scotch Lane" <br />If <br />4" 1 8" 1 12" Crosswalk <br />