408_Brooks WATER
Issued Finished P - 7411r Employee - 2 ` cf. -- map
Name: Address: 7 £ ov /C5
?hone ,cumber: (EM): (WR):
Time for Water locate
Check for: Aeeuncy tau :_ Mctsr Laak: Meek avatar pteaaure: raids! meter relocation inspection Re -teed
1.3ackflow Insp. 2. Repair 3.Maintenance 4.Other
Hackflow Insp. A.Main Line A.Pumps A.Line Locate
B.Valves B.Water Tower B.Inspection
3k_low Cer .Date C.Service Line C.Saalples C.Tap
D.Hydrants D.Equipment D.Excavation
Re -Cert. Date E_Safety
5. Reason for 5ai'_ure: A. Electrolysis B. New construction C. Poor installation.
D. Other
a. List of safety equient at site if applicable:
A. Barricades 3. Cones C. Tape D. Lights E. Other
Request for Serviceman: •
7._f Meter /Service Leak: Classify - City: Customer:
A. Water Loss (Estimami: GPM Fire plug flushing Total Gallons
3.Was Water Metered: Yes No
,,.Was Customer Notified: Verbally
Vehicle /Equipment Used
3.35 Homer Change Out: Unit if Miles Firs Equip
A. Old Meter# `l -` 7 8 fc. 7 Readin t 0 p
3. New Meter# a/ 0 v l 3 Reading 0 7
C.Old Meter Size /Type i2Utd,11/e/r! /e X D. New Meter Size /Type J'' ,
E.Type of work performed or findings: C 11 'l am O
4'
9.1! mainline or deep servi repair, describe type of pipe or service line and condition:
10.Manhours: "'tom Crew members:
11.List Materials Used:
12.If you had an accident /Lncldent while performing this request. Dim sport it? yet or no
13.water Utilities meter inspection: pass or fail �
14.How many trips to do task? , 1