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Service Request <br />Request Information <br />Request No <br />Date <br />Time 3 , 0 <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 />(�G ;; /�,..y,. <br />Street <br />►� J 3r,t A1w� — r,/± e: ry a. <br />Cross Street <br />City <br />Problem Details I-t<< <br />/I �" V 'tl -�✓' � I ` i r �... �i-f L! E...G._ -. r /.�1� �' �� la �"' <br />Problem Code <br />Down Date <br />Down Time <br />Assignment information <br />Assigned To Randal Dale <br />Responded Date <br />Time <br />Work Order <br />Left Time <br />Comments <br />/ <br />Completed 0 (.! Date: <br />- <br />(name..... &employee #) <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harmless\SR_graffiti _ v3.doc <br />