1009 •
WA '
issued: /40/ Plaisbab r Ealc o m Al % Grid -- •
Plt a `r..i: eEFt�ty • y / Address: .O tiir _ _ _i
).
Check :or A :1==y ;. meter Leek Check aster pressure:
lnidal =ter reiondem inspezzi ons Re-read
1. Backr1= (ma. 2- Bank 3. _ail • 4. Saw
Bacdow (asp. A. Main Line A. Pump • A. Lies Lowe
B3c:'a v Ctn Dace B. Valves B. Water Towner B. Lice Locate
Re -C-: Dam C. Service tine C. Samples C Tip
D. Hydrants D. Equipment D Excandoo
E. Safety
S. Lama for bane: A. E1ee*rolysisi B. New Coasesscsioa C Pon tasdlniaa D. Other
6 . List of safety egaipamt at sits if appliadale
A. Barricades B. Coon C Tape D.Lights E err
Rribitt:tftc
aita/ktle- 0 -61 7. li M Bemire Laic Classify: - City: Customer
A. :Vox Los: ( ar ): GPM Fire plug flushing Taal Callous
B. Was Water Maine& Yes No
C. Wu Casa=` notified: Verbally Doadmodar -
V=hicJerEquipmeut Geed
3. ( `::._. �=L: ;.
� =` Ct:it ; tiCla tits Egt:igmeac
A. 9 2 I/ 2 2 Reading / 7 Yo
�r <� 3. New Me•.=: _ �_I- Ws Rading a
C. Old Meter : ;fie: HIAPGLA s /� D New Meter SizeType / s e s/e
E. Type awed perforated or fg `ovT ,7.400
9. if =3 -- :r :e: ;r- '- :: repair, describe • of pipe or ser 'ice ;..= zed condition:
O Go w � ,CeN r 2
4/e I'2 INV '0 /a O / !U/ / ,,/ ?D /air
! /03 1 9. /y- /02 o } ftZZ
It C:,: ;r:
l.. _ z: i : :._.... __:C_zc •. :'r_ ;e:foncting this :c? Y:s ..:c
13. 'x 3::: Lczl;ces .ter:: ss;eeciart: pass or fail
1 t. Edov .:1:(T. � s AWk