i

s

ia
“

see
TPES,
ee

Pay

oy

wena d
ten il

Pale ini

y. .

TNA Om enhee ery mend set Sa ee + cig tet we mee #8 5+ a mane Coma Oe etenmeee in we one

WR O68 s germ pay

“

ENGINEERING DEPARTMENT - REQUEST 8 INQUIRY
| LOCATION OF PROBLEM: pate: Arif /4t

A
Time: 4: OO Peay In Person
By Phone

No.: 473 194 | By mail
Name: Rau Sa les TO: Anne Puwenbuy
/ conf

Address: 226% Lrvi Me Ave. Construction ~ sy
Phone No.: (Home) 442-95 92. (Work)

Engineering inspection

REPORTED THAT: ig / at if : | Parks

: j ’ | 4
el fA £Y | .| Public Works

Trades & Sanitation

Utilities
yet _ | ~~
She gies ws __ FOREMAN:

Report Taken“By.
ann an See Originator

4

fetes Investigate & Report

Take Necessary Action
Instructions By

‘ beeen

UE ASE
19 oh peice he
sagt :