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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
zyA-
REQUEST
Date h- /)....-62
Time
Received by
(phone, person)
Location of Work to be inspected 41 q S I L'5+ (
Name of person requesting inspection I w " J (0 r:
Address of person requesting inspection 11 f11 1J f3 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other uJ <<'\...:..~ e r
INSPECTION NOTES
Inspected Date
Remarks
Time
!f.~ 00. ('r-r:d
'7'J1-e:-kr I
By
h~ c Ie 5 ( d'-e /S ~
RESTORATION REQUIRED
YES
/
NO!/'
1 /V1' n
S1"- v
t
... x-'( /I- C
..
s--rJ/
...
Iy~ I
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
RfC()MPLETE
o INCOMPLETE
o Other
~I <f /
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
1) "'" . 4.00 T . '2-1 &.{ I
IWork Order No' ~I LI (
DATE REPORTED' b -- / D -- 0 J.- J
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. b -/).. -- b .2.-TIME 1, {; 0
REPAIR LOCA TI0N ADDRESS 4 I q 5:
2. ~ (---S-
TYPE OF MAIN SIZE.
ICrew.
11f
~.M. DP.M.
J- 5+ (
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
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~CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVED BARREL 0
OTIIER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOn... AREA 0 SOn... 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 12. q P.P.M.
WATEROFF FROM 1 /-} M. TO g,x>Jt. /~{)US -e d u1-
FROM M. TO
M.
;(ul) f <' d' () u 1- -F('-fh7,
APPARENT CAUSE OF LEAK.