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Always indicate specific section on sketch if multiple values for material,method of installation,size,or year installed(if year is available)are applicable to a single service. Not intended to be inclusive of all possible symbols. This section is for reference only. E ----Gas Line(New) ® Meter Anode Reducer 4+OR-0-EFV -W Valve with Frame and Cover 8 Gas Line(Existing) UMMeter Manifold ® Electronic Marker Service Tee —D OR —)Cap Pipe Size and Material(Casing Size and Material)Insert •Main •Material •Name of nearest cross street Instructions for DeacftMallans: •Service pipe 8 •Method of install per •Name of street The following is the minimum information required •Service tee 2 a TD-4461M:Trench,HDD, •North arrow when documenting deactivations on the GSR. ' •Pressure classification:High pressure(HP), c splitting,dry bore,insert c •Street address .Location of gas flow termination semi-high pressure(SHP),low pressure o .Pipe size ¢ •Dimension service tee to service end •Installed assets related to deactivation(e.g. (LP),transmission pressure(TP) c •Status:New or existing •Dimension service tee to nearest cross street electronic markers,end caps,plugs) ^ — •Existing pipe:Year •Mother/branch service a •Deactivated pipe:Length,material,size installed,if available o •Casing length •Deactivated pipe:Year installed,if available •New cathodic protection(e.g.anode) -o � P P `o ., •Deactivated pipe length •Deactivated pipe •Casing material E Date deactivation work was completed in •Width ofvossstreet •Electronic markers •Casing size w `o accordance with TD-9500P-16 '$ ,� e •Repairs:Dimension from service tee or riser 3 •Fittings per TD-4461M — •Joint trench(IT) g •LAN ID and signature or printed name of and length of repair z g ^ •Curb valve Pipe size the qualified field representative a •Partial replacement:Dimension from service r+ o •Excessflowvalve .Material ^ °1 performing requiredtest(s)and/or s.. 3 a tee or riser and length of installation $'a •Meter/manifold T e:Main or service 3 inspection(s) 2 • YD _ Stub Completion:Dimension from service a •Pipe casing ,^� o •Status:New or existingo •LAN ID and signature or printed name`of Regulating stations involved in or within ) 3 �. tee or riser and length of installation the person in charge responsible for • B B •System status:Tied(T)or .Manifold or large meter:Dimension p P close proximity to work a nstalling assets and performing work •Meter guardsdead ens year minimum distance required between related to deactivation Existing P pe:Ye structure and riser installed,if available •Excavation Agent:PG&E or Applicant •Method ofjoint connection per •Lateral offset:Dimension from service tee oTD-9500P-14-JA01 A •Casing material or riser •Deactivation order reference •LAN IO•of qualified individual performing •Casing size •Valves and fittings:Dimension from service v •Deactivated non-pipe assets,if connection Joint trench(Ji) tee or riser �_ available:material,size. PG&E Intemal 0 2019 Pacific Gas and Electric Company.All rights reserved.