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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT . . . . . .
.....
REQUEST
Date .5 - II - 0 <;-
c.' --0 A in(
Time 1:> ....\.
Received by /)C'KV{ is E (phone, person)
Location of Work to be inspected "'20 W
Name of person requesting inspection Ot..' M v1. 's
Address of person requesting inspection L.e r /J
Type of Inspection (circle appropriate one) (J
IO+~
C
Yo. rd / '7 If-D
Phone No
LIt 7 -'Ik'l.{CJ
Sewer Foundation Framing
Permit No_
Chimney Plumbing Final Sewer Excav Othe~
INSPECTION NOTES
Inspected Date 3 - II -iYS- Time
Remarks f< e./l a I/" 2-. (( C -:r:.. /I'lA-a... I V\.
c~~ 3' u<$"ck. ('jo' D'~
I I
12 5 U ('itA ByO-eHVlI S r::
w (-f k 2- 1:>r~><;e.~ 6,-,~ Il\{\ c; ')
I --.)
RESTORATION REQUIRED
YES
NO X
~
t- I --------- .
VI
\.... W lOl~ --s--r +-
\$ \J\
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\J " eL I ( ~ t -1< 22.<;/ ---?j
Z Z-z O-eeyJ ~
() , -0
/
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # 303'+2.-02. (
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No
5U 3'i 'L-02-(
,
I Crew 7 (-S- ~. cr
]
DATE REPORTED ?: -' ( ( -0 l)
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN CONlPLAlNT )(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.
5-II-d:;
TIME
DA.M. DP.M.
REP AIR LOCATION ADDRESS S- 2-D 0, I 0 -+-~
TYPE OF MAIN e..- 7. SIZE Z I.
; (
DEPTH OF MAIN Z Z- CLOSEST VALVE DEPTIl 3
COMPONENT REPAIRED.
MAIN JOINT 0 CrR. BREAKSJ( SPLIT BELL 0 LONG BREAK D
HOLE 0 CLAMP 0 OTHER
SER VICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERo( OTHER S ~J"._ 8' 0 IZ LI. L ~
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRlVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING UU Ii /A..-{.d TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORlNE RESIDUAL SAIv1PLE f~A p P M.
WATER OFF FROM I () ;" "Atvr. TO ! I 39ifM.
FROM
M.TO
M.
6rou1Ad L.ft (~
APPARENT CAUSE OF LEAK. r,- ~