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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date .5 - 2-5 ~os-
Time (I ~ 30 If'^'- Received by f)eM v11 5 E (phone, person)
Location of Work to be inspected S-O~ Slue t.J'?t -fe f
Name of person requesting inspection A.vt1;1. (S E- .
Address of person requesting inspection Gr,a y{..r d IfC(.-B.
Type of Inspection (circle appropriate one) I
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Sewer Foundation Framing
Chimney Plumbing Final
Phone No f./ (7-- Cf-f?t/ 9
Permit No
Sewer Excav Othe~)
INSPECTION NOTES
Inspected Date 3- 25 -0 ~
Remarks
Time 2- 30 jJPvL By Uev.. t/l15 €
RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # 303 1b --()2-~
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 "5o,~'f~ rOz-~
I Crew 71'S" i-&ew
]
DATE REPORTED
:5 --Z-S-.--O S
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAlNT t8:..
LEAKAGE SURVEY 0 OTHER 0
TYPE OF MAIN
"3 - 'L S-- -() :s-
ADDRESS S-tlb
c.T
TIME L 30 DA.M. r2RM.
81J~ J~-f-e{' ~ec,J
DATE OF REF AIR.
REF AIR LOCATION
"
SIZE. 2-
I
DEPTH OF MAIN 3"'Z CLOSEST VALVE DEPTII.
,
Z-~
COMPONENT REI' AIRED.
MAIN JOINT D Crn.. BREAK D SFLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING 0
METER SETTER PC METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COl\1PONENTS OF REF AIR. CLAMPO DRESSERO OTHER /t{eh.r Slwt- ~* } Lo(.N\..;J U /1\..1 ~V\ r
, I '3/t( fJ.S
SITE CONDITION GRAVEL 0 ASPHALT D SIDEWA,LK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE IV k. +, c/ .e...
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE tJ A p P M.
WATER OFF FROM
/ 'D(1M. TO L P M.
FROM
\1. TO M.
A.PP.A.RENT CAUSE OF LEAK SO [cLet' -.-II ~ I ",-1- {€ ~,lc; ~