2001_0517 •� • -
WATER
Issued: 5 —t ) - 0 IFinished:5-1 -D 1 Employee: Grid map:
Name: Address:
Phone Number: (FDA) (WK):
Check for. Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. $acktlow Insp. 2. Revak 3. Maintenance 4. Other
Backlog• Lnsp. A. Main Line A. Pump A. Line Locate
Bktlo-.v C: _ Date B. Valves B. Water Tower . B. Line Locate
Re -Cer_ Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New Construction C Poor Installation D. Other
6. List of safety equipment at site if applicable•.
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services: 7 4 z - r A OUT
7. If Meter: Service Leak: Classify: - City: Customer
A. W ater Loss (estimate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/Equipment used
3. If Meter C:ange Out: Unit 4 Miles Hrs Equipment
A. Old Meter 90 (03Ok r Readingd&, oJ 3
3. New Meter T p9G, c. f S </ 4/ Reading DC O O
C. Old Meter Size':y e: D New Meter SizeffypeS$ MASTf12-
E. Type of work performed or findings:
9. If rrai li: a or deep service repair, describe type of pipe or service line and condition:
i'). eta- ..__.. Crew Merr:ers. 8,
11. Lis: Nta:t7:ais Used:
12. (f; a:: an sccidea;.:: :::dent while performing this request. D:d you serer: a' Yes or no
13. Water Utilities meter irsection: pass or fail
14. How many nips to do ask'
Si enatur