2000_0828 •
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• WATER
Issued: epF/006 E Coed map:
: Addresr �
Phoee Number: set- ON) ( ): - — — - -
Check :or. Ar:utxy Meter Leafs: Check water pressure:
Initial teeter reload= iasceoas Re -read
I. Back Tow Imo 2- &WC 3 Main► • 4. Qom[
Bac ±Tow Insp. A. Maio Line A. Pump . A. Line Lode
Beam Cr Dace B. Valves B. water Tower B. Lice Locate
Ile -Ce:: Date C. Service Line C. Samples C Tip
D. Hydrants D. Equipment D Excava Loa
E. Safety
5. Rasta foe failure A. Electrolysis B. New Construction C Poor faced dsion D. Other
6. List of safety equipment at site if applicable: .
A. Barricades B. Coca C Tape D. Lights E Otbar
Request for Services: / K..1
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a P pPii Pt e
7. If Met= Service Laic Classify: - City: Customer
A. Water Lou (ate): GPM Fire plug flushing Total Gallons
B. was WaterMesececk Yes No
C. Wu Castor= `oaf ed: Verbally Dood®ockr -
Veehic!erEquipmeat Used
3 ` : :._- :.:aa3e C�._ Unit* NCIes Hrs Equipment
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A. C d ate :: - _ 996577 �' Reading 7 Z'
3. `e Mete; _ „/7 y.3lG Rading 1
C. Old Metter SizrT.pe: D New Meter Size :tyre
E. Type ewes performed or findings:
9. I r3 =Lire or •'e_; ferric : :e ,air, describe e type of pipe or service tine and condition:
, ce ' j -c1 P7 re._ tStJ • 73C , e - „s
er
A. Opp S e S !- , a
'‘') --..-..-.: ..:1 C:2' Me: 0 .T/
I l L:,: .ti:_ -rs r
l'_. , _ 1.i� is is :._t :.. _ . -:drat .... ^.i- re:fc.:.tirtg this :trues:. Ord :iv. :: ;c- .c7 Y :s: :o
13. 'W'a : :: Utilities met:: rs eccion: pass ar fail
14 . licr.• .:1z trips s wk'