Austin Place-WO 970506Phone: (hm). -- (wk) yT~ 07~ 7
"lype of m~t~rial A. Concrete* 2. Na(lfi'e of
B. Asphalt A. Holding water
C. Gravel B. Pot hole
D. Dirt C. Mud hole
*Street Repair__
D.Previous site has s~ttled ~
E. Rolling street ~
G. Other
, Alley Repair , Sidewalk Repair Sq. Ft. Priority i 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. Sate of Texas
C. The contractor G. Other
D. The developer
How were the repairs made:
A. Cut out and blocked yes no
B. If concrete - was it doweled and pinned with steel, yes no
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 particles yes 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?
L Was a roller used yes no
Note why did this problem occur A. Settling of site
B. Poor construction
C. Shoulder rolling off
D. Turning radius
E. Other
Were ba-mcades used yes or no
Were barricades removed yes or no
Barricades for Other Departments
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 rej~on: yes or
no