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Service Request <br />Request Information <br />Request No <br />C) Op 0: Status OP <br />Recorded By <br />Billing Code <br />Customer Infor lation <br />C) <br />V <br />Customer Name <br />Address <br />Apartment No <br />City <br />Zip <br />Phone No <br />Ext <br />Second -Phone Ext <br />E - M ail Address <br />Problem Information <br />Address <br />Street <br />Cross Street <br />City <br />Problem Details L �C73 <br />C <br />' LD V_1j <br />C) <br />Problem Code SGRIFTI <br />Down Date <br />Down Time <br />Assignment information <br />Assigned To Randal Dale <br />Responded Date <br />Time <br />D " 0 0 <br />Left Date <br />Left Time <br />Wor Order No. <br />Comments <br />Date: <br />Completed By: I (name ..... &employee #) <br />P:\TrafficOperations\Traff-IcMaint enance\Graffit affiti AGraffiti Hold Harmless\SR — Y3.doc <br />