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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date 1- II - 0 S
Time 8:%A YV\.
Received by .De y{ Yl l.s [
(phone, person)
Location of Work to be inspected ( Z ( \A.J
Name of person requesting inspection P-elAvt \.,
Address of person requesting inspection c:o r ~
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
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/ "/ 4- g Phone No '1(7 -'-I '81./-9
Permit No -;;-:--,
Sewer Excav Ot~~
INSPECTION NOTES
Inspected Date / -II -05' Time
Remarks ReDo... f v Z / <::.. - :c f1A..o- l "" b r € q k.
be-. ~d
By
it.); f- k a..
5-S
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RESTORA TION REQUIRED YES NO '"x
f ~
~
~\ ~ 1 . €} ~
187 ' >f Z"-CT. -Z ~' O.Le..p
----
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt D PCC D Other
Work Order # 303 y;z - (-;c C;
.
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No JO,3 i;<- C"C'1
/Crew 7/5" "'i- Cre.w
J
DATE REPORTED /-,. 7-0 5"""
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT )(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. 1- I? -Ie' os-
TIME B'ys
l Z-1 - W ~-fr".
){A.M. DP.M.
REP AIR LOCATION ADDRESS
TYPE OF MAIN C-. r SIZE 2 (I
j ;
DEPTH OF MAIN 2 Z. CLOSEST VALVE DEPTH.
z
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK ~ 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 VAL VE 0 BARREL 0
OTHER
COMPONENTS OF REP AIR. CLAMP)( DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ~ SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING
EXTERNAL CORROSION
CHLORINE RESIDUAL SAMPLE/2~ P P M.
!VIA
TUBERCULATION-MINOR 0 SEVERE 0
OCALIZED 0 EXTENSIVE 0
WATEROFF FROM 10 A M. TO 10 loAM.
FROM M. TO M.
APP '\RENT CAUSE OF LEAK. b (0 J 1"lJ. ~ '