| Name: | Peri Bell | Phone: | 530-802-1233 |
| Email: | the8bells@outlook.com | Address: | 5671, Pennyroyal Dr, Pollock Pines, 95726 |
| APN: | 07726210100 | Nearest Cross Street: | Sierra Springs |
| Owner of Property: | Yes | Number of Piles: | 3 |
| Pile Size in Feet: | Total width :5, Total length :15, Total height :4 | 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: | 6 | Hired someone, how much did it cost: | |
| Applicant agreed to waiver: | yes |
Service Instance | | | |
| Contractor Name: | Admin | Date Serviced (mm/dd/yyyy): | 06/19/2019 |
| Travel Time (in minutes): | 7 | Chipping Time (in minutes): | 30 |
| Actual Pile Size (in feet) | | Total Pile Width: | 16 |
| Total Pile Length: | 6 | Total Pile Height: | 4 |
| Supervisor: | Jose | Crew ID : | |
