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Service Request <br />muq U CJ 111 11 v1 11 1Q L. <br />Request No Date <br />Time � ��� Stat�usOP ���� <br />Recorded By <br />Billing Code <br />Customer Information <br />L)<T > <br />/ice - !� <br />Customer Name <br />Apartment No <br />Address <br />City <br />Zip <br />Ext <br />Second Phone ( ) Ext <br />Phone No ( ) <br />E -Mail Address <br />Problem Information <br />Address <br />Street <br />Cross Street <br />.,. <br />Problem Details j� <br />} <br />Problem Code SGRFTI <br />Down Date Down Time <br />Assignment Information <br />Assigned To Randal Dale <br />Responded Date Time 12'3,0 <br />Left Date Left Time ; <br />Work Order No. <br />Comments <br />Completed By: <br />Date: <br />(name ..... &employee #) <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harmless \SR_graffiti_v3.doc <br />