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CITY OF P,ORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
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REQUEST:
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Date - "/6 -- 0 I
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
. 26 It, , W 4J~
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I --1 t /1, i-- '- Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
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INSPECTION NOTES:
Inspected: Date
Remarks:
Time By
(R-ff(\,'y- S-evU I'(~ t.-e~k hy.
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RESTORATION REQUiRED...... YES L/ NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel 0 Asphalt
(Continue on reverse side if necessary)
~c 0 Other
:ork Order # 117 I)') i 12. c l\ 1
1'\' COMPLETe3-;>/;f;H k -IJ--'") ./
o INCOMPLETE c::><(\V
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
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Do No ((epL~ WIT'
STREET SUPERINTENDENT (DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
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IWork Order No: I I 70
,
Reported: LILI (."" I"
Repaired: 1-1 9 I ~ !
'Crew:
-1/y
Condition:
Source:
Emergency Routine
Citizen Complaint L /
Leakage Survey _ Other
Repair Location:
Address:
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Loc. Description:
Component Repaired:
Main Line ID#:
Main:
Joint Cir, Break
Long. Break _ Hole
Split Bell _
Clamp _
Other
Service:
Une Valve:
Hydrant:
Other:
Tap _ Corp, Stop _
Flange Nuts. Bolts
Branch Valve
Pi V
pe-
Stem
Barrel
Curb Stop _
Bonnet
Repair Type: Clamp _
Site Condition: Surface
Curb
Damage:
Cuts: Street Cut: Ft.
Dresser
Other ff-f A j ..tU
('" l' , , 'e 411 J f' --el~- --1",
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Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter: Inches
Material :
Depth of Cover: Ft.
Internal Lining:
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Joint Type:
External Prot:
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Tuberculation: N/ A
External Corrosion: N/A
Special Conditions: Bedding:
Minor
Localized
Severe
Extensive
Other Structures:
Apparent Cau.e of Leak:
Samples Taken: Pipe Section _ Coupon _It/~ ~/_-e
Water Off: From L/ l/ D l To 3-.A-M / A (;, U)---Q-
FromL/!J-/4 To-kAM I hy.
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5/19/98
Page 1
PW-902.09