| Name: | Jan Wall | Phone: | 530-748-3850 |
| Email: | robertscottwall000@outlook.com | Address: | 2621, Morrene Drive, Placerville, 95667 |
| APN: | 05041006100 | Nearest Cross Street: | Bush Court |
| Owner of Property: | Yes | Number of Piles: | 4 |
| Pile Size in Feet: | Total width :8, Total length :8, Total height :6 | Material location: | Shoulder of Road |
| Alternative disposition of material: | Leave it on Property | How material was cut and stacked: | I cut and stacked the material myself |
| Number of hours required to do the job: | 4 | Hired someone, how much did it cost: | |
| Applicant agreed to waiver: | yes |
Service Instance | | | |
| Contractor Name: | Admin | Date Serviced (mm/dd/yyyy): | 06/18/2019 |
| Travel Time (in minutes): | 19 | Chipping Time (in minutes): | 20 |
| Actual Pile Size (in feet) | | Total Pile Width: | 3 |
| Total Pile Length: | 57 | Total Pile Height: | 4 |
| Supervisor: | Brian K | Crew ID : | |
