| Name: | Lyman-LOGTOWN Dennis | Phone: | 707-330-1018 |
| Email: | Ldennis@eldoradohc.com | Address: | 5880, Stope Way, El Dorado, 95623 |
| APN: | 09213102100 | Nearest Cross Street: | Quartz Dr. |
| Owner of Property: | Yes | Number of Piles: | 1 |
| Pile Size in Feet: | Total width :5, Total length :12, Total height :3 | Material location: | Shoulder of Road |
| Alternative disposition of material: | Take it to El Dorado Disposal | How material was cut and stacked: | I cut and stacked the material myself |
| Number of hours required to do the job: | 10 | Hired someone, how much did it cost: | |
| Applicant agreed to waiver: | yes |
Service Instance | | | |
| Contractor Name: | Admin | Date Serviced (mm/dd/yyyy): | 06/10/2019 |
| Travel Time (in minutes): | 14 | Chipping Time (in minutes): | 23 |
| Actual Pile Size (in feet) | | Total Pile Width: | 4 |
| Total Pile Length: | 10 | Total Pile Height: | 5 |
| Supervisor: | Jose | Crew ID : | |
