2000_0828 •
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WATER
Issued: (• a Q ' '2 - 00
Grid asap:
' Address:
Phor.:
Number: (10.(}
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Check for: Accuracy ;. Meta Leak Check arster pressure:
Initial =ever retoatice �speenoas Re
I. Bahr tow [aso. 2_ Blair 3. Mainteeamt 4. Qom[
Baceow Lam. A. Main Line A. Pump A. Line Locate
Bk.:7ow Cert. Dace B. Valves B. water Tower B. Lime Locate
Re•C -:_ Dace C. Service Line C. Samples C. Tip
D. Hydrants D. Equipment D Excavation
E. Safety
S. Reason for fallut= A. Electrolysis B. New Ca iininios C Poor taso"n3os D. Other
6. List of safety a uipmeat *site if applicable:
A. Barricades B. Cases C. Tape D. Lights E. Other
Request for Services:
7. Ii MeterlService. Lak Classify: - City: Customer
£. Wirer Loss (es re): GPM Fire plug flushing Total Gallons
B. Wu Water Moue& Yes No
C. Wu Castoma Notified: Verbally DooEbodcx -
VehickEquipmeeat Used
3. tf �� �� ` ..... ` sage C'.: Unit # Nees firs Eguiptmeat
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.. Na ijum - mfr •
A. Reading
3. New Me- ? 2. 7'1 6 .C`/ Reading
C. Old Meter 5�-.T pc: 0 New Meter Size Tpie 7, h fa" �c P
E. Type of watt performed or findings: A/e c eSo N►
1:5 C? 1 . aWr d - ( 9 O ' 7 4 . - 7 t 1 ,• a t G c w[. v 4,1 2 c-40
9. tf 7.1::Lize or Fete ;e-r; Nair describe type of pipe or ser';ce line and rendition:
,'7 _, /, a - w. //.`e.
z ` �7�,�
re ::'c ling this .•Ilesz. O. you Y:s
13. lettuces :re er rreecion: pass or fail
l S- How many trigs 0 :o ut['