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I <br />Service Request <br />RPrmt-qt Information 1 <br />- <br />Problem Details - C o 1 � <br />/ 9 ,,1 - I c� 3 (o-- 15 - L9 � <br />Problem Code SGRFTI <br />Down Date Down Time <br />Assignment Information <br />Assigned To Randal Dale <br />Responded Date Time <br />Left Date Left Time <br />Work Order No. <br />Comments <br />Completed By: Date: — <br />(name ..... &employee #) <br />:r <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harrnless\SR_9raffiti_v3.doc <br />Vv <br />Request No <br />Date �r�� <br />c1 <br />Time <br />S <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 />Problem Details - C o 1 � <br />/ 9 ,,1 - I c� 3 (o-- 15 - L9 � <br />Problem Code SGRFTI <br />Down Date Down Time <br />Assignment Information <br />Assigned To Randal Dale <br />Responded Date Time <br />Left Date Left Time <br />Work Order No. <br />Comments <br />Completed By: Date: — <br />(name ..... &employee #) <br />:r <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harrnless\SR_9raffiti_v3.doc <br />