345 Charleston • WATER
rseued
Finished smpLoyee _�� �.. Grid map
Name: - OOF r= 1) I d / 0
Phone Number: (HM): ( WX )
Time for water locate
Check for: Mammy Wa___ ustse Closet *&sepamen: leioaimosemioesdsoeirpeciee__ Irani
1.8ackflow rnso. 2. geaair 3- Maintenance
Backflow Insp. A.Mairt Line �.Lthe=
A.Pvmps Jl.Line Locate
B- Valves B.Water Tower B.Znspection
8kflow Cert.Date C.Service Line C.Saaples C.Tap
• D.Eydrants D.Equipment D.Excavation
Re -Cart. Date E.Safety
S. Reason for failure: A. Electrolysis 8. New construction C. Poor inatallatio•
6. List of safety equipment at site if applicable: D. other
A. Barricades B. Cones C. Tape D. Lights 1. Other
Request for Serviceman :
A " ifv G //t1 C' ' V
7.If Meter /Service Leak: Classify - City: Customer: �—
A.Weter Loss (F GPM ___ Vire plug flushing _ Total Gallons
B.Was 'rater Metered: • Yes _____ No
C. Was Customer Notified: Verbally DOOZICIOCCIR __
• Vehicle/3quipmeat Used
$.If Meter Change Out: Unit # Riles Firs 3quip�
A.01d Meter# Readin -S 6 (Q
8. New Meter #,2 2 ( JV ( e Reading
•
C.OLd Meter Sise/ D. `'
zYPe D New Meter Size /Type
E.Type of work performed or findings:
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Kanhours: 1 " members: ,
1./.Gist Materials Used:
12. re you had an accident /LncLdent while performing this est. 01d you report Lt? yes or nc
1l.0 i el‘ UtLlLties meter inspection: pass or fail \ + r
L1.Hcw many tripe to do task? _