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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT . . . . . . . . . . .
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REQUEST:
Date 2. - I { - 0 Z-
Time
Received by
(phone, person)
Location of Work to be inspected I Z g uJ, .3 rc1
Name of person requesting inspection r w; I C-.o V
Address of person requesting inspection Carp Vc..rJ
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No.
Permit No. ~
Sewer Excav. Oth0~+~.J""
INSPECTION NOTES:
Inspected: Date
Remarks: t€e ..06.1',.-- ed
I
Time By
Z-il c.r. i-V\a..,V\. w"itk full cure...! e.- repcz..:r bd
RESTORATION REQUIRED. . . . .. YES
NOX
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel o Asphalt OPCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order # 2o<-/-(..,.
dJ/COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Departnlent
'" ater Distribution Repair Report
IWork Order No:
CONDITION:
~o q ~ ICrew: I / Y
2 '-{l- 6 L-
EMERGENCY D ROUTINE D CITIZEN COMPLAINT V
LEAKAGE SURVEY D OTHER D
DATE REPORTED:
DATE OF REPAIR: 2 _ (\ - () 2.
TTh1E: DA.M. OP.M.
J?---1 ..w 3 v{l
REPAIR LOCATI0N: ADDRESS:
TYPE OF MAIN:
'l < ( -r
tf'. C~..v- SIZE:
DEPTII OF MAIN: '3 I
CLOSEST VALVE DEPlli:
COMPONENT REPAIRED: , /'
MAIN: JOINT 0 CIR. BREAK t( SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE: TAP 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OlliER:
COMPONENTS OF REPADl.: ~RESSERO 0TIffiR
SITE CONDITION: GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRIVEWAY CUT _FT.
" I-A
MAIN CONDITION: INTERNAL LINING ~ TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M. f<JrA''v'~tI uhcl-ey po55t-f(u-f...
fr f' 55 Uv-Z... .
WATER OFF: FROM M. TO M.
FROM
M.TO
M.
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APPARENT CAUSE OF LEAK: