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CITY OF PORT ANGELES vvrj-SV I ~_____________-
DEPARTMENT OF PUBLIC WORKS ~"'J /2- 8 'Z
. . . . . . INSPECTION REPORT. . . . . . . . . . . 7
REQUEST
Date I ..30 - .:;La.) ':J-
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
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Phone No
Permit No
Plumbing Final Sewer Excav Other LA) Ot-/-.e It
INSPECTION NOTES
Inspected Date Time By
Remarks
~--epctt'l\. ~ ~ 't c:.. r~ W\.~.'...J naf"~ t:l3 ' W-es. t eX-
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RESTORATION REQUIRED
YES J NO
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0
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC~ Other ~r4'\~,<;
o Repaired by City Work Order # ~o 3 I
[] Repaired by Permittee 0 COMPLETE
[] No Damage Found 0 INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No: ~03 \
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DATE REPORTED ,.. 3~) - ol...()O L
CONDITION EMERGENCY ~ ROUTINE D CITIZEN COMPLAINT D
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR.. \ -30- ~c.:l-
TIME \ .30
DA.M. ){P.M.
REPAIR LOCATION ADDRESS "4~4 S _ Op. Ie
TYPE OF MAIN c.A~. -+ -:I: c- 0 :"'I
1,1
SIZE.~
,
DEPTH OF MAIN 3
CLOSEST VALVE DEPTH. )....5
COMPONENT REPAIRED:
MAIN JOINT D CIR. BREAK 'ri. SPLIT BELL D LONG BREAK D
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM D BONNET D
HYDRANT BRANCH D VALVED BARREL D
OTHER.
....,
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER ~\t cMd~ r~c-.~ bA~
SITE CONDITION GRAVEL D ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA X SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRlVEWAYCUT _FT
MAIN CONDITION INTERNAL LINING ~J I A TUBERCULATION-MINOR 0 SEVERE D
EXTERNAL CORROSION ' LOCALIZED)( EXTENSIVE D
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM
M.TO
M.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK.
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