2000_0918 •
A y ) 1 6%
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W A T E R -
Issued: � � ' : - r z .
EmPloYoc 6 ,y Geed
Phone `strce^.. (Fitt{} Address / L ') ewe- - "7 Sr /_ e"
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Check tor: A.:urscy — ?ge Cease Check water pressure:
taieal =ever fel4X26211 iaspeed, oas Re-read
1. Back :tow tom, 2- Rank 3- Miinaniin= i. 9!h¢
Bacdow tarp. A. Maize Line A. Pump A. Lies Locate
Cr Dace B. Valves B. Water Tower B. Line Locate
tee -Ce : Dace C. Service Line C. Samples C Tap
D. Hydrants D. Equipment D E:oavadaa •
E. Safety
S. Reason for Wine A. EI.cuolysis B. Nam Conswtaion C Pool Tn." -' as D. Other
6. List of safety equipoises ails if applicable
A. Barricades B. Cones C. Tape D. Lights E Ohl
Request for Services: ls' 1 : v ti ,, C -- .n . - 7
7. If M Service Lalc Classify: - City: / Customer
A. star Loss (este): GPM Fire plug Hushing Total Gallons
3. Was Waterer Yes No
C. Wu Ces ei e Notified: verbally Doak:othr -
Vehicle:Equipment Used
3. t ` ::._. `:a.;ge Cs._ Uric 4 Ales fin Egaipr etc
A . 0 1 . . 4 . = S'' / / L ca Reading 6z. 3 if3.
3. `ew Meta; : 2 `7 /. '? V,' Reading '1
C. Old MemT 3z" ;fie: /f f 4.6 , e 0 New Meter Siz =Tye
E. Type of work perforated or darlings:
9. If or ae:� :e - : :e?air, describe type of pipe or ser' ce tine std mortician:
L') ..1: - : _ ; Z . 3 C:2 e: s. t
this .:gies:. Did you :c- :c? Yes
1 3. Ws::: Laltces s eecion: � or fail
1 S. HOW .—r..ml caps