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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT . . . . . .
.....
REQUEST
Date ] -J D '-0 ')
Time 7 : 0'0 /J~ Received by
(phone, person)
Location of Work to be inspected ;<0;) 7 lA/ I 0 1 ~
Name of person requesting inspection 6..../cA..f.e r il ,/
Address of person requesting inspection I 7 u ~ ( )" a L3
Type of Inspection (circle appropriate one)
Sewer Foundation Framing
Chimney Plumbing Final
Phone No 9/7- C./1!'/7
Permit.--No
Sewer Excav ~~~~C.(. r e r
INSPECTION NOTES
Inspected Date J - ,] u- (.)-=J
Remarks
Time I D .'..0 ~t"fiy 7 / 7
/lerJPo.v I Je..((;/Jc-e
14..4?, ~
I I) J#e I~,r
RESTORATION REQUIRED .
YES V NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved DGravel o Asphalt OPCC l;I.Other/O(/ SUI/
o Repaired by City Work Order # 3uJ~6 -o~tl
. . ,
o Repaired by Permittee ~ COMPLETE
o No Damage Found 0 INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public vVorks Department
Water DIstribution Repair Report
IWork Order No 0:) D3 Lj 6~o~'1 f
'Crew 7/~1 7/~ 7t?l;;lJ 7;<:; J
DATE REPORTED .) -;})' -0 S--
CONDITION E1'v1ERGENCY 0 ROUTINE}( CITIZEN COMPLAlNT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAiR,
J <)t?~O ~ TIME </ t/l? ~AM. OP.M,
ADDRESS :J. 0;< 7 tv / o"~
REP AlR LOCATION
TYPE OF MAIN C r SIZE ,J- '"
DEPTII OF MAIN :) 't " CLOSEST VALVE DEPTII. 3'"
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SER VICE TAP 0 CORP STOP 0 PIPE X CURB STOP 0 FITTING 0
METER SEITER 0 METER d.'
LINE VALVE, FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER 3if /1Z;.l:.r~/;,/J 5r~L.~ /~~I.,f;I'C 11(:- ~
I ) , - J n 'jP(;
SITE CONDITION GRA VEL 0 A~P. T 0 SIDEWALK 0 CURB 0
TOP SOIL AREA SOIL TYPE
CUTS ASPHAL T CUT _IT URB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING A/ ~ TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE dp,p M.
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APP.4RENT CA.USE OF LEAK
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