Coppell_SandyLake •
WATER y `
Zssued , c �.
?inhed Lmploye. �� Grid map
•
Name: Address: es/LA.S_ of • . . 4 , • sol A A_
?hone Number: (EM): (W1C) :
Time for water locate
Check for: Attune: taw_ Meta L.a __ Meek water pressure: Initial meta Woeatioe iaspectioe Roised
I.Backflow /nets., 2. Revai: 3.Mainteaance Cahn
Backflow Insp. A.Main Line A.Pumps k.Line Locate
B.Valves B.Water Tower B.Znspection
Bkflow Cert.Date_ C.Service Line C.Samples C.Tap
D.3ydrants D.Equipment D.Excavation
Re-Cert. Date E. Safety
Reason for :a`- 'lure: A. Electrolysis B. New construction C. Poor installation.
S.
u. Other
O. List of safety equipment at site if applicable: •
A. 3aricades 3. Cones C. Tape D. Lights E. Other .
Request for Serviceman: 1A141 /& 5. LAC k
/acs h Irk
7._f Meter/Service Leak: Classify - City: Customer: __
GPM ? ire plug flushing
;. hate_ Loss (Fstimatsb: P g g Total Gallons
3. spas Kate: Metered: Yes __ No _ __
:.Was Customer Notified: Verbally DOOR»OCIO R
Vehicle/Equipment Used t
3.1f Meter Change Out Unit # Miles Brs Equip
A.Old Meter* .2 / 3 b ` 7 Reading d f 7O '
2 Reading D r
3. New Meter* a q b 3 /
C.Old Meter Sire /Type: 2 111/ • • - ----0.---New Meter Size/Type Os %/ . .
:.Type of work performed or findings:
A r P14111 ft- 0
9.If mainline or deep service repair, describe type of pipe or service line and condition:
•
10.4anhours: I Crew members; ;
il.List Materials Used:,
12.If you had an accident /incident while performing this request. Did you report it? yes or no
13.Water Utilities enter inspection: pass or fail
14.fow many tripe to do tank? 43L-.)> A
Signature,