City /County Contact Person: Cell Phone: Jurisdictional Pump Station(s) Time of Shutdown: to be Shut Down: Other Jurisdictional / Government / Private Pump Station(s) Why: affected by Shut Down: Location to take Sewage from Shutdown: (include map and details on receiving facilities) Location to take Grit/Material from Shutdown: (include map and details on receiving facilities) □ □NO Start Time: YES Air Injection Location: CONTRACTOR will Blow Air: A.M. / P.M. Planned time at which service will be restored: A.M. / P.M. Latest worst-case time at which service will be restored: Special Conditions or Requirements: Attach Contractor’s Work Plan Below Contractor’s Work Plan (List detailed step-by-step procedure with approximate times for each step / milestone)
City /County Contact Person: Cell Phone: Jurisdictional Pump Station(s) to be Shut Down: Time of Shutdown: Other Jurisdictional / Government / Private Pump Station(s) affected by Shut Down: Why: Location to take Sewage from Shutdown: (include map and details on receiving facilities) Location to take Grit/Material from Shutdown: (include map and details on receiving facilities) CONTRACTOR will Blow Air: □ YES □NO Start Time: Air Injection Location: Planned time at which service will be restored: A.M. / P.M. Latest worst-case time at which service will be restored: A.M. / P.M. Special Conditions or Requirements: Attach Contractor’s Work Plan Below Contractor’s Work Plan (List detailed step-by-step procedure with approximate times for each step / milestone)