2001_0508 WATER
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Issued: Finished: 5 - `-' Employee: ) ( "1 � -Oct Grid ( map:
Name: Address: . 7a I J4S it T-C1 y-
Phone Number: (1-LM) (WK):
Check for: Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bktlow Cert. Date B. Valves B. Water Tower B. Line Locate
Re -Cert. 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
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Request for Services: 7:29 /1 C° r" c� n - .4F e �. h C� r� �� - e ✓fi
7. If Meter /Service Leak: Classify: - City: Customer
A. Water Loss (estimate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/Equipment used
8. If Meter Change Out: q Unit 4 Miles Hrs Equipment
A. Old Meter 4 ` 0 I I 86,1 Reading 1 �' - 34'2cto
B. New Meter e 4 9. 75 1 Reading
C. Old Meter SizerType: rr as.! D New Meter SizeiType - %4' P2,9510,-
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10 a� U^ 1/ meters. 1 hg,5
11. List Materials Used:
12. [f you had an accidentl:.cident while performing this request. Did you report it? Yes or no
13. Water Utilities meter inspection: pas or fail
14. How many trips to do task?
Signature ��` .*