312_Brooks (2) WATER
aeued a finished 3 - s Employee ' /i / a f 1 'I Grid map
Name: Address: 3/ /J ✓o0/I5
?hone Number: (HM) : (WR) :
:isme for Water locate
Check tor: Accuracy use_ Mctar Leak: Check water pressure: initial miser relocation inspection mod
1.3ackflaw Inso. 2. Repair 3.Maintenance d.other
Backflow Insp. A.Main Line A.Pumps A.Line Locate
B.Valves B.Water Tower B.Inspection
Bkflow Cer't.Date C.Service Line C.Samples C.Tap
3.Hydrants 3.Equipment 3.ExcavatLan
Re -Cert. Date E.Safety
5. Reason fcr failure: A. Electrolysis B. New construction C. Poor installation.
D. Other
o. List of safety equipment at site if applicable:
R. Barricades 3. Cones C. Tape D. Lights E. Other
Request for Serviceman:
7.:f Meter /Service Leak: Classify - City: • Customer:
A.Water Loss (Fstimats;: GPM Fire plug flushing Total Gallons
3.Was Water Metered: Yes No
:.Was Customer Notified: Verbally DOORRNOCRZ:R
Vehicle /Equipment Used
3.!f Meter Change Out: Unit # Miles Mrs Equip
A.Old Meter* ' e4 1 3 ,1 Reading 2 q 3U
(
3. New Meter # A 1 0 `? ? `{ 6 Reading 6
C.Old Meter Size /Type: 4 10 S / i 3 / 7 D. New Meter Size /Type /'Q iLf r
or '(}} C l'ac4 v ° 3. Type of work performed r findings: • Z� �t V
(0/1 c Soo e-1 oct. 4s+ 7 y Co 3
44\ADN.1 mc4or ` /3/ 7
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: 5 Crew members: 1
I1.List Materials Used:
12.If you had an accident /incident while performing this request. Did your port it? yes or no
13.Water Utilities meter inspection: pans or fail � V�
14.How many trips to do task? , I