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Service Request <br />Request Information <br />Request No Date Time <br />Recorded By <br />Billing Code <br />Status OP <br />Customer Information <br />Customer Name <br />Address Apartment No <br />City Zip <br />Phone No ( ) Ext Second .Phone ( ) <br />E -Mail Address <br />Problem Information <br />Address Street <br />Cross Street <br />Problem Details <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 />a <br />Date: <br />Completed By: <br />(name ..... &employee #) <br />P:\ TrafficOperations \TrafficMaintenance \Graffiti \Graffiti Hold Harmless\SR —gr affiti _ v3.doc <br />Time <br />Ext <br />— &17 1 LI (17; <br />Down Time <br />