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Service Request <br />racy u��................... <br />Request No Date/ 3 �d <br />Time Status OP <br />i <br />Recorded By <br />Billing Code <br />Customer Information <br />Customer Name <br />Address <br />Apartment No <br />City <br />Zip <br />Phone No ( ) Ext <br />Second Phone ( ) Ext <br />E -Mail Address <br />Problem Information <br />Address Street <br />Cross Street <br />R <br />Problem Details <br />Problem Code SGRF n <br />Down Date Down Time <br />Assignment Information <br />Assigned To Randal Dale <br />Responded Date Time l6 _ I t -V <br />Left Date Left Time <br />Work Order No. <br />Comments �� (_ <br />M <br />Completed B �,c ` ''" °M° C C Date: <br />(name ..... &employee #) <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harm1ess \SR_graffiti_v3.doc <br />