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2001_0517
- WATER Issued: 5 —("7 —o ( Finished: 5 - (7 - 01 Employee: Grid map: Name: Address: Phone Number: (FLM) (WK): Check for .:curacy test: Meter Leak: Check water pressure: Initial meter relocation inst:e^-tioas Re -read 1. Backflow Insp. 2. Repair 3. Maintenance 4. Other Backflow Insp. A. Main Line A. Pump A. Line Locate Bkflow Ctn. 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: 1 /!'T & n " Q © .7 ( 7. If Mete:; Service Leak: Classify: - City: Customer A. Water Loss (est:Wate): GPM Fire plug flushing Total Gallons B. Was Water Metered: Yes No C. Was Customer Notified: Verbally Doorknocker - Vehicle/Equipment used 3. If M: ::: C:aage Out: Unit 4 Miles Hrs Equipment A. Old Meter 4 q(1 .45) Ts" Q Reading X - 73W 3. New Meter 4 ato y $ '2 Q Reading f �r2_ C. Old Meter Size. Tppe: L- D New Meter SizeiType i/14ST 'R - E. Type of work perforrned or findings: 9. If tr.ai:li.e or deep service repair, describe type of pipe or service line and condition: 10. Ufa- ..__.. Crew Me-:e :s. a44Ltt/013 11. Lis: `•11:.::ais Used: 1?. If =ate an accident : :: :dent while perfct:ning this request. D :d you report x? Yes or no 13. Water Utilities meter irsrection: pass or fail 14. How =any zips to do ask? Sienature