1999_0614 G WATER
sued Finished / /y G! Employee 5('ij Grid map
:tame: Address: /co 1 KP,c1 L. pAJol, fjeilht
?:zone ;lumber: (EN) : (W):
::ne for Water locate
Check for: Accuracyua:____ Mcssr Lsak: Cleet water pressure: Waal sow :slocatioaiJpr o: R♦frAd
1.3ackflow Insp. 2. Repair, 3.Maintenance
l.other
Sack:low Insp. A.Main Line A.Pumps A.Liae Locate
3.Valves B.Water Tower & Inspection
3kflow Cert.Date C.Service Line C.Samples C.Tap
D.Hydrants D.Zquipment D.Excavation
Re -Cert. Date E.Safety
S. Reason fcr failure: A. Electrolysis B. New construction C. Poor installation.
D. Other
6. List of safety equipment at site if applicable:
A. 3arricades 3. Canes C. Tape D. Lights 3. Other
Request. for Serviceman: Giro k,e )Vefeg P.hanl ' 0V-{--- .
7.If Meier /Service Leak: Classify - City: Customer:
A.Water Loss (Eaimw.ct: GPM ?ire plug f lushing Total Gallons
3.Was Water Metered: Yes No
,,.Was Customer Notified: Verbally
rJ 067% Vehicle /Equipment Used
3.1%.1 Meter Change Out: 6 0 S`'2S" Unit # Miles Ers Equip
3..Old Meter# A00000 Readin / 11 15 2.Rc.5 Q
3.New Meter# 025/ .55 Reading I
C.Old Meter Size /Type: 0 4 fid'a Q rs... D. New Meter Size /Type 5 /
C
E.Type of work performed or findings:
9.Z: mainline or deep service repair, describe type of pipe or service line and condition:
10.M anhours: Cre members:
LL.List Materials Used:
L2.If you had an accident /incident while performing this request. Did you report it? yes or no
:Z.Wauc utilities meter inspection: pass or fail
� £ / �J
: 4 . Hav many trips to do *4z?
i724-e/ c pppp
S Lenatu_ s ___