2001_0517 WATER
Issued: 5 — Finished: 5-1 7-1C2 / Employee: Grid tap:
Name: Address:
Phone Numher (} v() (WK):
Check for Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backtlow Insp. 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Below 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: K ETOC- Q c) CST
7. If Meter; 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 -
VehiclerEquipment used
3. If Meier Ceange Out: Unit 4 Miles Hrs Equipment
A. Old Meter 4 0 ' Reading g35 2
B. New Meter 4 -jI ][WO Reading «Di p,p
C. Old Meter Size. yQe: 'V/ a, . D New Meter Sizerrype- pAARrat
E. Type of work performe •' • r endings:
9. If mairlirie or deep service repair, describe type of pipe or service line and condition:
10. Ma: ..:_.. Crew y(e:- :e :s. e��A1tiae (80.13
11. Lis: Ma:e ais Used: J
12. If ? :c =azt an actide n: _. ::dent while perfcr:ning this request. D :d you :e ;cr: :t? Yes or no
l3. Water Utilities meter irsection: pass or fail
13. How many nips to do ask?
Signature