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2001_0510 WATER Issued: 5-10--0 ( Finished: 5't O--0 I Employee: Grid tap: Name: Address: 61..9,3 Phone Number. (FLNI) (WK): Check for. Accuracy test: Meter Leak: Check water pressure: Initial meter relocation inspections Re -read 1. $acktlow Insp. 2. jtepair 3. Maintenance 4. Qdut Backflow tnsp. A. Main Line A. Pump A. Line Locate Bktlow Cert. Date B. Valves B. Water Tower . B. Line Locate Re-Cert. 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: k r't 7. If MeterService Leak: Classify: - City: Customer A. Water Loss (estimate): GPM Fire plug flushing Total Gallons B. Was Water Metered: Yes No C. Was Customer Notified: Verbally Doorknocker - Vehicle/Equipment Used 8. If Mete: (Mange Out: Unit T Miles Firs Equipment A. Old Meter 4 go c93 / 3 Reading 4 B. New Meter s LJ °I 7 Reading Gb© • C. Old Meter Size.T :Te: vg D New Meter Sizei Type .5<ir Jv't AS Tt✓itZ:._ E. Type of work performed or findings: 9. If mainline or deep service repair, describe type of pipe or service line and condition: 10. Mai c_.. Crew M ::-crs.d E Aff 11. List Ma :er ais Used: 12. If you had an accident ::.::dent while performing this request. D :d you report it? Yes or no O. Water Utilities meter inspection: pass or fail 14. How .:.xty tips to do ask? Signature