2001_0426 WATER
Issued: Finished: 4 f —2,(0 "' ( Employee: l l l') i t+2` Grid map:
Name: Address: S 7
Phone Number: (I-LN[) (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
Bkrlow Cep 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: IV e40,- 1 / , p cc 4
7. If MeterService 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 -
VehiclefEquipment used
3. If Meer Caange Out: Unit 4 Miles Hrs Equipment
A. Old Meter .. c /C` .). 7S Reading J 61 1
B. New Meter 4 ab tJ / i J) Reading
C. Old Meter Size.Type: prfctsien W vow Meter SizefType fl943k0" 5/6
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Ala - c.- . ) L4'6 Crew Nlerr:bers.
11. List Ma:e :ais Used:
12. If you nad as aczident'-c:dent while performing this request. Did you report it? Yes or no
13. Water Utilities meter inspection: pas or fail
14. How ,;.any trips to do :ask ? .
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