ST9302-CS 970304Name: F-. G
Phone: (hm)
9.
10.
I1.
12.
Finished
*Street Repair
ROAD/ALLEYS
EmployeeA r6'y
Address:
(wk)
-~-/,,/ T3-1¢__. A. Concrete* 2.
B. Asphalt A.
C. Gravel B.
/,,lei~epair C.
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Nature of Problem
Holding water
Pot hole
Mud hole
, Sidewalk Repair
Grid map
C_.
E. Rolling street
F. Tree Roots
G. Other
__Sq. Ft.3OoO Priority 1 2 or
3
Who caused the problem or who is responsible for the problem
A. The city E. Another utility company
B. The customer F. State of Texas
C. The contractor G. Other
D. The developer
How were the repairs made:
A. Cut out and blocked
yes
yes
B. If concrete - was it doweled and pinned with steel.
C. If asphalt - was site cleaned out
2 inch yes no
D. If asphalt - was site dry yes no
E. If asphalt - was site cleaned from dust or lose particlesyes no
F. If asphalt - was TAC added to all joints. yes no
G. If asphalt - was seal coat applied? yes no
H. If site is asphalt or base, was it compacted with a yes no
"Wacker Packer" or Jumping Jack?
I. Was a roller used yes
Note why did this problem occur A. Settling of site
B. Poor construction
C. Shoulder rolling off
D. Turning radius
E. Other
Were barricades used yes or no
Were barricades removed yes or no
Barricades for Other Departments
no
no
no
Were the customers informed yes or no
Was door knocker left yes or no
Weather conditions
A. Dry D. Cold
B. Wet E. Other
C. Hot
Does the ditch need cleaned out: yes
Does the culvert need to be cleaned or replaced:yes
Do the brick pavers need to be replaced: yes
Was there an accident/incident: yes
How many trips to do task?
Or no
or no
or no
or no
Signature
Did you report: yes or no