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CITY OF PORT ANGELES / ~ \ >~
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date II - 11-- ~ '3
Time
II 5' c /7,'" f?,4tf-eK
I /ljll Received by E /?/C- (phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
~ ~ .> /,A/ )(1 // $ e)'
1/1 c. L
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date / I-II -C J
Remarks S' ~ I< // / C F L IN €
Time I ~ .~ # /1/11 By
L e><1~ I/vc t/ IV
/f#{r
/5.4C)'C'
5JPlJ
RESTORATION REQUIRED
YES
NO ~
SURFACE RESTORATION
SURFAC TYPE D Unimproved D Gravel
S e; I 6~ Repaired by City
\ " ~ [] Repaired by Permittee
J 0 No Damage Found
o Asphalt 0 PCC
Work Order # wr ....
~OMPLETE
o INCOMPLETE
D Other
)/ '3 ~p
HAl? 7t' leA~ Atf/'/?/(-r
r IX EP I r /I~I ? - ~ S
(Continue on reverse side if necessary)
CO/vctRer!? WALt.. THE C/(Ek
STREET SUPERINTENDENT (DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
) J SSCJ
IWork Order No' III/f I ( ) .ft/
ICrew. I(~/y, pe /'lA/I>, :f~jv/'" I
.
DATE REPORTED' II -I / - (J 3
CONDITION EMERGENCY ~ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. /1- 11- V J TIME
REP AIR LOCATION ADDRESS t ;. s
II : I > 91\.M. DP.M.
W fI/ p/?e,v
TYPE OF MAIN
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE w/"'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 REPAIR. CLAMPD DRESSERD OTHER C 1/'7 IN > ec.. T/P,v ~r .J' e-~rICc ll""c
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE 11 I If T
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE L' ;''1 P.P.M.
WATEROFF FROM I}~()~ PM. TO i;)'Y5 PM.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. ">E T T eiC cv# 5' L. e4~//Y'~ r