300 N Denton Tap 3 �./ WATER �-�— (` ('�
Issued: 9 . d Q p Finished: J '/7 Employee: 01 :'t T (/ Grid Map:
Name: Address: P."1/)1'k. V
Phone Number (HM): (WK):
Check For: Accuracy Test Meter Leak Check Water Pressure
Initial Meter Relocation Inspections Re -Read
1. Backflow Insp. 2. $hair 3. Maintenance 4. gltbk
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkflow 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. ights E. Other
// c� 5 /c�J 7�J� <�
REQUEST FOR SERVICES: � Ln e <'�t t' t 5 /- )0.4 /YI � try' /(���✓
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
8. If Meter Change Out:
A. Old Meter # 9 0 f ' /3 Reading 2 )' 3
B. New Meter # ' 7 n'....3 1 Reading p=
C. Old Meter Size / Type New Meter Size / Type
z
^
E. Type of work performed or findings: (7 ,to) � d ' . � •
9. If mainline or deep service repair, describe type of pipe or service line and condition:
I
L III
10. Man hours: Crew members: 71 — ' 7
11. List materials used:
a,A
12. If you had an accident incident while performing this request, did you report it? YES or . 4
l 3. Water Utilities meter inspection: PASS or FAIL z
X
14. How many trips to do task?
jig Signature , o
N o
a U