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Pacifc Gas and Gas Service Record (GSR) F°rmTD-95DDale:03/20/219 Electric Com an Publication Date:05/20/2019 Company• If completing this form by hand,use non-erasable blue or black ink. Effective Date:OS/20/2019 Map/Plat/Block:23/f10/29 Lot# Notif.#:115429046 Address:3701 NEVADA STREET pelica City:PLEASANTON PM Order#:35081056 n ract Name:SUSAN FRIEDLANDI,(510)809-2769 Est.LAN ID: 13PH Date Issued: 6/25/19 Leak#: Install Pipe: [I No[I Yes Install Pipe: ❑No❑Yes ❑New Phased Service Type:❑PE2406/2708 ❑Other: Type:❑PE2406/2708 ❑Other: ❑Stub a Performance/ a Performance/ ❑Stub Completion d Mfg: ❑Drlscoplex [I Other d Mfg: ❑Drlscoplex El Other: New Service: Mfg Date: Mfg Date: ®Full Service NEW FULL SERVICE ❑Branch Service-Ref.# Type: ❑Stub ®Other: Type:❑Completion❑Other: Replacement: Excavation Agent: ❑PG&E ®Applicant = Excavation Agent: []PG&E ❑Applicant ❑Full Service a Installation Agent: []PG&E ®Applicant a Installation Agent: ❑PG&E ❑Applicant ❑Partial Service B H B �m ❑Branch Service-Ref.# Z y (Person in charge LAN ID and signature or printed name') Z y (Person in charge LAN ID and signature or printed name') ❑Riser Date: Date: ❑Transfer ❑Afteration ❑Soap Test []Soap Test ❑Repair SE Tested by: N Tested by: ❑Deactivation H Qualified field rep.LAN ID and signature or printed name') N (Qualified field rep.LAN ID and signature or printed name ❑Uprate F Date: Date: Convertto:❑Main❑Service Pressure: prig Duration: min. Pressure: psig Duration: min. ❑Other Main:-- in. Status:®None❑Existing❑Installed Reason None:EFVSLECTTOOL W Status:❑None❑Existin J g []Installed uu MatT0 Plastic❑Metallic Flow Series:❑400❑Boo❑Other: MatTEDPlastic ❑Metallic o Installed Stub/Service: in. Size:❑1/2"❑1"❑Other: In. rc Size:❑1/2"❑1"®Other: 1-1/4' in. a Existing Stub/Service: in. Mfg:❑Elster-Perfection❑Other: 'W Mfg: Status:❑None❑Existing❑Installed Status:❑Existing❑Installed Size:1-1/4 X 1-1/4 in. 95 Type:❑Cathodic Protection Size: ®locating Size: #10 ffiN Location:®Outside❑Inside Bypass:❑No®Yes 3 Start:®Main❑Branch❑Other: Connection Method:®Bond❑Strap/Wrap ¢ Type:®Prefabricated ❑Service Head Adapter ❑Steel End:®Riser❑Branch❑Other: Connection Method:❑Bond[XI Strap/Wrap Riser ValveMf.:❑Jomar❑Other: Isolated Steel Service OSSI: ®No[]Yes El Existing CP Read Required: ®No❑Yes : Weld Inspection Required: []No❑Yes Anode:❑No❑Existing[Installed Size: lbs. By: Z By: N IQualifed field rep.LAN ID and signature or printed name') C (Qualified field rep.LAN ID and signature or printed name') Type:❑Zinc❑Magnesium #Installed: Pipe-to-Soil: mV Date: 3 Date: cc Location:El Riser ❑Valve❑Service Reading Location:❑Riser❑Valve❑Service Type:❑Radiographic El Visual❑Mag.Particle As-Built By: Contractor: Date: Q (LAN ID) (Name and company name) pAs-Built By: Contractor: Date: (LAN ID) (Name and company name) APPLICANT TO INSTALL 1-1/4"PL GAS SERVICE TO PROPOSED METER LOCATION.PG&E TO PERFORM HOT TIE-IN s Z 'If LAN ID is not available,write name and company name;include employee identifier if available. Draw sketch in space below. BU OF YAIERWS: A (331(016078)WE POLYEDX IN 1-1/4'PS SW 10 (A-9 ; _ (33�(294414)WIRE E1ECIRIGIL INS COPPER 600N 10ANG(A-90z) I = N (281(379947)TAPE IEARNING PP X GAS U/C(L-16) —t (1)(650208)TEE TAPPING TIED VOLULIE M x 1-1/4'PS(8-90.3) j Ir 1 (1)(032813)VALVE PLASDC 1-1/4'PS 11.25-84210—VB(F-90) (4)(021554)WRING 1-1/4'PS P369-52-1015—M(8-91.1) 8'-- (1)(041037)RISER GAS SERVICE 1-1/4'X 1-1/4'PS(A-91) SUNFLOWER HILL WAY (33.5') (1)(374944)NO EXIEIOED WINCE EIAl1 EMS YETLDN(N-60) FA.C. IT1 —— 1-1/4'HP FL (IREN" 28r #3701 I I I I i I I 23—F10 BLOCK: 29 PLEASANTON, CA N�pOA StREEt PG&E Internal 0 2019 Pacific Gas and Electric Company.All rights reserved.