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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS /----/Zt:f3
. . . . . . INSPECTION REPORT. . . . . . . . . . .
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(phone, person)
~ ~ 2-00 1- ~ 21 c) 2.-
REQUEST
Date )/ A - 62-
Time
Received by
Location of Work to be inspected 7 I ~ 5 ~I{l ( ( -e y
Name of person requesting inspection T w \ \ u )(.'
Address of person requesting inspection 11 tJ, -t- B Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L (. ~t'"l t-e V
INSPECTION NOTES
Inspected Date
Remarks
(.!. vl)tt
Time, By
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RESTORATION REQUIRED
. YES
NO [,/
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IVt
71 ~I <........
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5+
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
7 51 jJil
z
o Repaired by City
CJ Repaired by Permittee
CI No Damage Found
Work Order #
o Other
2/ 6 ?--
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
", ater Distribution Repair Report
\)c.u .2.CJOl--UO.
'Work Order No.
~I D ?-
I Crew' '7/9'
1
DATE REPORTED f) - 1- 6 L
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~.
LEAKAGE SURVEY 0 OTIIER D
DATE OF REPAIR.
5>:J-- 6:2-
TIME,
REPAIR LOCA TI0N
ADDRESS
7/l{
/j t?~
/ 7 DA.M. OP.M.
S Vctll-ey'
TYPE OF MAIN
a ( It C
~ SIZE.
4. y, t
L. - CLOSEST VALVE DEPTII.
DEPTH OF MAIN
COMPONENT REPAIRED:
MAIN JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLAMP D OTIIER
SERVICE TAP D CORP STOP D PIPE /CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VALVE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTIIER
..
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SITE CONDITION GRAVEL D ASPHALT D SIDEWALK D CURB D
TOP SOn.. AREA D SOn.. TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING Jf/ /-4- ruBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CJ-ll.,ORINE RESIDUAL SAMPLE i"3 2-P,P.M.
WATER OFF FROM
9A
M.TO
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I
01./'
FROM
M.TO
M.
13;.-,' fffJ2 p f:- $.e i-VI (,~ PIP~
APPARENT CAUSE OF LEAK.