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500 Christi WATER _ `` `� Z aaued i i::ished S ' b` Employee �`C ` Grid ma :lame: - -._._� `�- � � p Address: u s Q I,�tt ?hone Number: (3M): ( WX ): • Time for We locate Check for: Accuracy tent_ Metar Laic Check eater minim: &tidal meta relocation inspectioa Rs.ssad I.3ackflow Inst. 2. Reflair, 3.Maintenance `.other Backflow Insp. A.Main Line A.Pumpa A.Line Locate B.Valves B.Water Tower B.Inspection Bk_low Cerr.Date C.Service Line C.Samples C.Tap 3.3ydrants 3.Equipment 3.Excavation Re -Cert. Date 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 3. Cones C. Tape D. Lights E. Other Request for Serviceman: 7.:f Meter /Service Leak: Classify - City: Customer: .Water Loss (Fatimmei: GPM Fire plug f lushing Total Gallons 3.Was Water Metered: Yes No -.Was Customer Notified: verbally vehicle /Equipment Used 3.If Meter Change Out: �7 Unit # Miles Ers quip A.Old Meter# ? 7L /O U / oR eadin / / / 3. New Meter# , a L3 ui s 3 Reading 07 ) C.O1d Meter Size /Type: 644-e• � � �< ` r p , D . New tsr Size /Type M R04'C � r� �Y�/ I . Type of work performed or findings: 4 4?-71 ‹. C tq `- q� ©`1 T V 9.If mainline or deep service repair, describe type of pipe or service line and condition: 10.Manhour s: _ Crew members: T L1.List Materials Used: .2.If you had an accident /incident while performing this request. Did you report it? yes or no :3.Water Utilities meter inspectioT pass or fail .4.How many trips to do task? l /-� S igna:ure, / /044;