1999_0424 :sated WAR
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Name: ✓A j . Grin map
:lone Y AdcreaI:
• Number: : (EN) :
:. a :or Water locate
G:teck
for: Accunov we :—. Mctr Lc&
Cheek mater pressure: Initial matt relocation inspection Rs - mad
1.8ackf low Insp. 2. Repair 3.4aintenance `.other
Hack:low Insp. A.Main Line A.pumps A.Line Locate
3.Valves B.Water Tower B.Inspection
Bkflow cert.Date C.Service Line C.Samples C.Tap
Re –Cart. Date D.Hydrants D•Equtpment D.Excavation • E.Satety
E. Reason far = allure: A. Electrolysis B. New construction C. Poor installation.
D. Ocher
o. List of safety equi went 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; -
:,. Water Loss (Fsrit a : G?!i Fire plug flushing Total Gallons
3.Was water Metered: Yes No
:.Was Customer Notified: Verbally DOORICNOCEER
Vehicle/Equipment geed
a.Zf Meter Change Out: Unit # Hiles ars Equip
A.Old Meter# � 1 J c 3) ReadingCC; 7'
3. New Meter# 1`,` y '1' Reading
.Old Meter Sise /Type. s P . L t 5 r �M \ �) 4 / s
r D. New Meter Size /Type / c. S/ f r y r zy"
3. Type of work performed or findings: r ! i C A c y7 - ) ;, / -
9 .I: mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: :f4 Crew members: 1
11.List Materials Used:
12.If you had an accident /incident while performing this request. Did you report it? yes or no
13.Water Utilities meter inspection: pass or fail
14.How many trips to do task? r -c 4.101! 1