2001_0517 •
•
WATER
Issued: 5 -1$-01 Finished: 5 — 1 ? — 0/ Employee: Gtid map:
Name: Address: /FA 6 8 &
Phone Nutrcer: (FC1) (WIC):
Check for. Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backrlow trip. 2. Repair 3. Maintenance 4. Other
Backlow Lltsp. A. Main Line A. Pump A. Line Locate
Bkflo x C. Date B. Valves B. Water Tower . B. Line Locate
Re -Cep_ Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New Construction C Poor Installation D. Other
6. List of safety equipment at site if applicable-.
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services: M E'TEl2 A or TT
7. If Meter. Service Leak: Classify: - City: Customer
A. W ater Loss (est: iate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
VehicleEquipment Used
3. If M_:e: Cage Out: Unit Miles Hrs Equipment
A. Old Meter Cld i / ?6,1 Reading 1 `752
3. New Meter 0 4 I$ 0 Reading
C. Old Meter Size-Tyne: e: g- 6 2.- D New Meter Size Type Si , -sFZP
E. Type of work performed or findings:
9. If mainline or deep service repair, descnbe type of pipe or service line and condition:
10. Ufa- `cam:: Crew Me:::e :s. (/l' "4./ehG /h0,
11. Lis: NIa:e-:als Used:
12. :lad in accident:. while performing this request. D :d you :ere.: a' Yes or no
13. Water Utilities meter inspection: pass or fail
14. How :many nips to do :ask?
Sienatur_ — --