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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST
Date II - ? 0 - 0 3
Time
Received by
(phone, person)
Location of Work to be inspected h ZD E B ( t/ {)
Name of person requesting inspection [)E-UJAJ cS E
Address of person requesting inspection 6Jr p y'",-r d
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
Phone No eft 7.:-- q 8'S<j-
Sewer EXC~er~:';o~~
INSPECTION NOTES
Inspected Date / ( - Z 0 ~ 0"3
Remarks J e I ~c '? -f "'- ' (Vl
rec~ ffc,-c ked -ro'{-tL-
Time
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RESTORATION REQUIRED
YES ~ NO
SURFACE RESTORATION ( 'IX 8 ')
SURFACE TYPE 0 Unimproved 0 Gravel M Asphalt 0 PCC 0 Other
o Repaired by City Work Order # (1'1t)~
[] Repaired by Permittee 0 COMPLETE !\'t~ ~~CN ~ W\ 't~
[] No Damage Found 0 INCOMPLETE ~C\ M, \( \ \ -7.l- (:) ~
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(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
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IWork Order No
DATE REPORTED'
l. / L{ ,)b
11-)7-61
I Crew
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CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINTW
LEAKAGE SURVEY 0 OTHER 0
DATEOFREPAIR.~-lq-61 TIME
b ;).. 6
b Ii It C
DA.M. DP.M.
REP AIR LOCATION ADDRESS
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TYPE OF MAIN
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE 0 CLAMP 0 OTHEl
SERVICE TAP 0 CORP STOP fII PIPE VCURB STOP D FITTING D
METER SETTER D METER D
5cicl/l~
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH D VAL VE D BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERD OTHER
SITE CONDITION GRAVEL D ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
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 i':<" 7 P.P.M.
WATER OFF FROM '8' A- M. TO J () It M.
! fJ/k ouf (j F
sP yLA. ~
FROM M. TO
APPARENT CAUSE OF LEAK D( c}
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