2001_0516 WATER
Issued: 5 I6, Finished: 5- — l 6 - 01 Employee: Grid asap:
Name: Address: 9 L TLL..tE
Phone Number: (FC'1) (WK)
Check for. A:curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. $ackilow Insp. 2. Repair 3. Maintenance 4. Other
Backflow tnsp. A. Main Line A. Pump A. Line Locate
Bktlow Cep Date B. Valves B. Water Tower . B. Line Locate
Re -Cer_ Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New Construction C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services: /1rI6 c.) c57
7. If MeterService Leak: Classify: - City: Customer
A. W ater Loss (estimate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/ Equipment Used
3. If Meter C:a nge Out: Unit Miles Hrs Equipment
A. C d Meter 4 ? l I qSq Reading h 2.372
B. New Meter T 6 $13 Reading e c �)
C. Old Meter Size Tyne: j V O f %Si Cld D New Meter SizeiType ' MAT
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Ufa- -:_.. Crew —
1 1. List Mh:e-:a:s Used:
1 If you ha: a : accident: :dent while performing this request. D:d you report ..t? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How many Tips to do ask?
Signature