312_Brooks WATER
Issued \\ ‘ - Finished Employee ..1 Xi_ Grid map
Name: 1 FZi�-T&` 3 1 YL J L Iez- c Address: 3 1 2 6 (Cr
Phone Number: (HS): (WE) :
Time for Water locate
Check for: Accuracy tat:__ Meter Leak: Check water pressure: Initial meter relocation inspection Re-read
1.Backflow Insp. 2. Repair 3.Maintenance 4.Other
Backflow Insp. A.Main Line A.Pumps A.Line Locate
B.Valves B.Water Tower B.Inspection
Bkflow Cert.Date C.Service Line C.Samples C.Tap
D.Hydrants D.Equipment D.Excavation
Re -Cert. Date E.Safety
5. Reason for failure: A. Electrolysis B. New construction C. Poor installation
a D. Other
6. List of safety quipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Serviceman: V\ Pt N f fL/ --i Yrt kc ('; 3 0
7.If Meter /Service Leak: Classify - City: Customer: �_
A.Water Loss (Estimate): GPM Fire plug flushing Total Gallons
H.Was Water Metered: - Yes No
C.Was Customer Notified: Verbally DOORINOCESA
Vehicle /Equipment Used
8. If Meter C �►u sZ D � O �'/ _ Unit # Miles Hrs E quip
! ( O � Vi
A.Old Meter...L ,, _ ; .e ding_ __ _ c r ?O /�'
B .New Meter #c2 / T 3 5I$ Reading
C.Old Meter Size /Type:
f/K/i/4(1'2 y ` D. Naw Meter Size /TypeJ�l� /
E.Type of work performed or findings:
»76+14 (APT P) (Z- CI v\ --k"
9.If mainline or deep service repair, describe type of pipe or service line and condition:
/1 „-
10.Manhours: Crew members: i
11.List Materials Used:
12.If you had an accident /incident while performing this nn rogues . DDid you report it? yes or no
13.Wator Utilities meter inspection: pass or fail l '
14.How many trips to do task ?`�
Signature