2001_0426 WATER
Issued: Finished: `h -6 " Employee: AP--/6 6 Grid map:
Name: Address: 51 / / Si -or c
Phone Number: (WK):
Check for: Accuracy test: Meter Leak: Check water pressurC =
Initial meter relocation inspections Re -read e
1. Back/ low Ipso. 2. Repair 3. Maintenance 4. Other
Backflow rasp. A. Main Line A. Pump A. Line Locate
Bkilow Cep Date B. Valves B. Water Tower B. Line Locate
Re 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: 7e 4t r 6 err
7. If Meter :Service Leak: Classify: - City: Customer
A. Water Loss (estisate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorkaocker
VehiclefEquipment used
3. If Mete- Change Out: unit T Miles Hrs Equipment
A. Old Meter 4 q 63 O1 Reading C LC( d
B. New Meter 7 2. Cp ( 3 1 Reading
C. Old Meter Size -Type: p D New Meter SizetType
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. ti1a: -c_.. / Crew Merr ±ers..
11. List Ma: trials Used:
1?. If you :-.ad a : accidenLL::dent while performing this request. Did you report :t? Yes or no
13. Water Utilities meter inspection: or fail
many 14. How any trips to do ask? /
Signature l i ` 1Z4/4