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Service Request <br />L <br />Request Information ✓ <br />(?'I ( V ' <br />Request No <br />Date �, <br />Time <br />Status OP <br />Recorded By <br />Billing Code <br />Customer Information <br />Customer Name <br />Address <br />Apartment No <br />City <br />Zip <br />Phone No ( ) <br />Ext <br />Second .Phone ( ) Ext <br />E -Mail Address <br />Problem Information <br />Address <br />Street <br />Cross Street <br />City <br />l . <br />Problem Details �' L `Q S t �"- \A-A � � V i t `` <br />\ `r .P !!, ) to ,� - l 1 3 5 — I ) q L,o 1 S� <br />Left Time <br />Problem Code SGRFTI <br />Down Date <br />Assignment Information <br />Assigned To Randal Dale <br />Responded Date <br />Left Date <br />Work Order No. <br />Comments <br />Date: <br />Completed By: <br />(name ..... &employee U <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harniless\SR_graffiti_O.doc <br />Time <br />Down Time <br />