313_Bricknell WATER
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sued 1 Finished: /� Enviers*: Oe- , -
crid map: -- -
Manie: k Address �l3 f iCKr
Phone Nub ( n () - (WK): . 2JI Q — r,' j3° k — a 9
Check for. Accuracy test - Meter Leak: Check water pressure:
Initial meter relocation ; woes Re -read
1. $ackflow Inv, 2. Repak 3. Maintenance 4. ibligt
Backflow rasp. A. Main Line A. Pump A. Line Locate
Bkf low Cert. Date B. Valves B. Water Tower B. Line Locate
Re- Ce.•t. Dace C. Service Line C Samples C. Tap
D. Hydrants D. Equ:-pmeat D Excavation
E. Safety
S. Reason for failure A. Electrolysis B. New Construction C Poor InstaIladon D. Other
6. List of safety egnipsneat at sire if applicable:..
A. Barricades B. Cones C. Tape D. Lights E. Otha
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Request for Services: k. - faQked. WCtker 44 — • • -f-1.i . prrh- - f t
•. a! ftrir 24._: Al: • ..�i 1n1n ningai - silitt: r' , •
7. If Meter'Serzce Leak: Cass:, - City: Customer
A. Water Loss (e =4: GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Wu Customs Verbally Doorlmocker -
VehiclelEquipment Used
8. If Me ::: Cu : Out: Unit Wiles His Equipment
A. Oid Meter 4 h . % Reading •
B. New Meter 4 , !& r Reading
C. Old Meter SizesT; pe: - a - ' b D New Meter SizerType /j'l�s 44 6 /
E. Type of work pafor...ed or Tdings:
9. If mainline q)dee� ,r,,ai r d il type of p'pe or ce line and condition:
10. Vitas - boors: Crew Members. / 7 -17
11. List Materials Used:
•
12. If you hid s- sc: :deco ? - :._ ::t .while performing this request. Did you rem :t:' Yes or no
13. Water LaIces meter ie:pe::cn: pus or fa :1
14. How many Sip to do task
Signature ji