1999_0907 WATE 4 t
rssued `� 99• 7inis:�s � FLoY� �A Grid sap
N amps : ( ! Address: - 3 0 . �2
?hone Number: (3.4): (uZ) :
Time for Water LOCL:e •
Check !or: Aseam:* as:_ )gins CAa& Crock waxer pceaiuce: Weld sow e.toa:iaa «°°� asnrl
..pack: Low Milo., 2. gecai2 3.Kaintenanca 4.4thec
mack:low insp. A.Mais Lino A.Pumps A.Lins LOCats
3. vL.*• 3. Fiats= Tower
3j on
Hk:Low Cer:.Da:e CA ....vice Line C.Samplas C.Tap
D . 3ydr ann s D .!quipment D .Excavation
Re -Car=. Dane -.. E.Sa.Sety
S. Reason __- failure: A. rlee- ..=olvsis 3. New construction C. ?oar izseaLla :ior.
D. CCher
e . Lis: of sager equipment a: site is appZicabls:
A. 3ar=icadss 3. Canes C. Tape / D. Lights E. Other
Raguest for Se vieesaa:, �1 �C 0 014 . �
H.=e: /Se:7ita :sic Classify - Ci y: Csstrme=:
ante_ Lc s s (uimu. :::.?M :ire plug flushing Total Gallons
3.Was Wa:er Menaced: Yu No
.:. Was Cuscomen lte wed: Verbally DOCIUDIOCUI
vehiclef3.ga.ipmsnt Qsed
3.:: Mater Clangs Cut: Unit # Miles !1 :quip
;.Ofd ma_e_ik 27200 f O Rao:..ng � /
- 1 6- 77 3. New Hscs: y /'7 Readin
C.OLd Meter Sins/Type: 3 X- / ":I • - ---C: --New )dace: Sisa /'i'ype 916" X3 / - , .. ..
I.Tvre a: wo:;c pe::ornad or fL :gs: - : t/';'(- 1 - 7c f
9.I` mainline or deep service :s;ii describe type at gape or se rice line and condition:
LI.Ki ^r outs: -f--- C:s saab
LL..r.:s: xa :•_ials Coed: I
L1. L: yav had an ac:Llint /GAcLde while perforating this :e<,ses:. ?ld you r.per. L= Yes at ac