337 Charleston WATER
issued finished 243191°Y.• _ s' Grid map ___
Name: es: 3 ) 7 (-1,1 ' /L -t J(\
Phone Number: (EH) : ( WX ) :
Time for water locate
Check for: Accuracy t r_,_ Ud., Lack Cheek inter Fumy Wad , —
l.Backflow 2nsn. 2. penair 1. d•grehlt
Backflow Insp. A.Main Liao A.Pumps A.Line Locate
B.valves 3.Water Tower B.Inspection
Bkflow Cert.0ate C.Servics Line C.Sasples C.Tap
• Re - cent. Date O'Bydrants D.squipment D.Excavatioa
E.Safety
S. Reason for failure: A. Electrolysis B. New construction C. Poor installatio-
6. List of safety equipment at site if applicable: D. other
A. Barricades 3. Cones C. Tape D. Lights 1. Other
Request for Servicssaas •
171/ . 7 -7 0-.X— C /7(/ / �`- ,
7.1f Meter/Service Leak: Classify- City: Customer: __
.
A.water Loss (Fseeru): GPM ?ire plug flushing Total Gallons
B.was Prater Metered: • Yes __ No __
C.was Customer Notified: verbally DOGICOMXICIE
• Vshicle/Equipeeat Disci
$.2f Meter Change Out: Gait # Miles Ern E
A.old Hate Reading ci''� l
1
B.New eter# 'Readies
C.Old Meter Size /Type: D. New lister Size /Type
E.Type of work performed or findings:
9.Lf mainline or deep service repair, describe type of pipe or service line and condition:
1
1a.Manhours: Crew members: - ".
1L.List Mateci i s Used:
12. re you had an accident /incident while performing this ceque t. id you report Lt? Yes or nc
13.uatec Utilities metec inspection: p ass or fall 4 ` \in
14.Hcw many trips to do task/