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site plan 109131964
Rev. 1June 7, 2013 CPRE -INSPECTION FORM ` Job: 1 ��3�aia�_"ho Date: 4 ` Jurisdiction:City / dip.` last. Start hate: Customer: �s Est. Duration; _ PM 1nsp; `► rusrnrdrtpHnrt xu e�R WorkDescri n tion Open Trench ❑ Trenchless [] [Mork Locatipa SiI CQt S uri ace 1` f Cl & 3tV of Cf r�: 'i� of CL" & of GL Nmof CL f CE ut3t s gar,✓ Plaggers a`#, Police Flaggers Trolley Lines Q Bus Stop" ❑ # Deter Hoods[] # Speed Limit _ mph ❑ # Traffic Signal ❑ ' Arterial ❑ No Parks E]� Commercial ❑ Altered Commercial ❑ Leak repair II Service Information Bollards ❑z.S91C�4"#__ Residential 2rAltered Residential ❑ CP Work Q Dhim-eter IVfe� V Template Bar El Multi --Family❑ Replacernentservice ❑ Pothole ❑ 5/8" ❑ 2S0 012800 ❑ Fuel Line Permit❑ New Service ❑'Main Maintenance ❑ Extension_ ❑ 11/8" X425 ❑ 2600 ❑ Fuel line Length�� Stub 2rService Maintenance[] Complete x1./4" ❑ 030 ❑ 10,000❑ Fuel Line Dlam, " Cut &Cap ❑ Valve Maintenance [j Service ❑ 2" ❑..10000 Meter Location.