308_Brooks WATER
-)� '7 Employee / e ( 1 4 / /� j Grid map
:asued Finished c.
:tame: Address: 30 // 7 715
?!zone Number: (324) : (WR) •
Time for Water locate
Check for: Amine:. test:_ Meter Leak: Qat water preaaute: teitial miter relocation inspection d
1.3ack_f1ow Inso. 2. Repair 3.Maintenance `.Other
Backflow Insp. A.Main Line A.Pumps A.Line Locate
3. Valves 3.Water Tower 3.Inspection
skflow Cert.Date C.Service Line C.Samples C.Tap
D.3ydrants D.Equipment D.Excavation
Re - Cert. Date E.Safety
�. Reason for failure: A. Electrolysis 3. New construction C. Poor installation•.
D. Other
6. List of safety equipment at site if applicable:
A. 3arricades 3. Cones C. Tape D. Lights E. Other
Request for Serviceman:
7.If Meter /Service Leak: Classify - City: Customer:
A.Water Loss (Estimate): GPM Fire plug flushing Total Gallons
3.Was Water Metered: Yes No
:.Was Customer Notified: verbally
Vehicle /Equipment Used
3.If Meter Change Out.: Unit # Hiles tars Equip
A. Old Meter* i n / '4 `' l r� Reading J-5 (3
I 1
3. New Meter # 1 0 1 A 5 Reading
; / •
C. Old Meter Size /Type: rr , IG ; I ( < i` /g/ D. New Meter Size /Type / d ' �' t ° ' � 5
S/
I. Type of work performed or findings: /44 • 4 Ply l7 /74 Eq(,, l'9 (-)/
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: 'a Crew members:
L1.List Materials Used:
12.If you had an accident /incident while performing this request. Did you report it? yes or no
I3.Water Utilities meter inspection: pass or fail
14.How many trips to do taakl �1
Signature f ri /Li 1 •