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I iwipii I" <br />MINNESOTA GAS CO. MAINTENANCE <br />a MAIN □ SERVICE P.C. NO.________ <br />DATE_______~ ___________MUNIC.r'- <br />ORDER NO. <br />NARUC OR E NO. <br />RESP. ACCT. NO. <br />LOCATION <br />NATURE OF WORK <br />SURFACE DISTURBED <br />□ ASPHALT O OIL <br />O CONCRCTE □ OIRT <br />O BLVD □ WALK □ ALLEY <br />Size OISTURMO <br />PIPE LENGTH <br />□ SAME <br />_ PT LONGER <br />_ PT SHORTER <br />i FT A0ANOOKCO <br />SERVICE TAP MEASUREMENT <br />DATE STARTED DATE COMPLETED FOREMAN r . j <br />To ths Minnsaots Gal Coirtpany <br />ParmiMion it haratoy grvttad tha Minna»ta G« CofT^wtv to trniimn <br />tha work indicatad abova. <br />______ of <br />Data By _ <br />lAuthortzHj Signtbira) <br />FcKm 4tA R1 t/71