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2001_0517 WATER [ssued� i -I 7 / Finished $-- (? -01 Employee: Grid map: Name: Address: 6 R67' Phone Number (HM) (WK): Check for A :curacy test: Meter Leak: Check water pressure: Initial meter relocation inspections Re -read 1. Backtlow Insp. 2. Revair 3. Maintenance 4. Other Backlow Lup. A. Main Line A. Pump A. Line Locate Bkrlo x• C:r_ Date B. Valves B. Water Tower . B. Line Locate Re -Cep_ 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: NI e - Ft"' /2- £ L53 c'T 7. If Meter; Service Leak: Classify: - City: Customer A. Water Loss (es 'mate): GPM Fire plug flushing Total Gallons B. Was Water Metered: Yes No C. Was Customer Notified: Verbally Doorknocker - VehiclefEquipment used 3. If Me : :: Ccange Out: Unit 4 Miles Hrs Equipment A. C d Meter 4 9b o h / 61 Reading 'i qQ Z.- 3. New Meter T 9f, y I Ss' , Reading ©2 C. Old Meter Size'Tyne: % Rn<<c (nAI D New Meter Sizeffype � rS TE n E. Type of work performed dr findings: 9. If mat: lit a or deep service repair, describe type of pipe or service line and condition O. Ufa- .. :_.. Crew NIemhe :s. ebtiv 11. Lis: Ni3:e-:a :s Used: 1 If ?ci. =ate 2:1 ac :idea::..: :dent while performing this request. D:d you ::port : :' Yes or no 13. Water Utilities meter inspection: pass or fail 14. How many :rips to do asc' Sienature