2000_0509 WATER
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Issue �: ais.�. S G7 Employee: Grid map:
Name: Address: 1 7V �ueGGO
Phorte Number: (KM) 972 -355 57 5 OM:
Check for Accuracy :est: Meter Leak: Check water pressure:
Initial Teter relocation inspec-doas Re -read
1. Backrlow Insp. 2. Repair 3. Maintenance 4. Other
Backlow Ins°. A. Main Line A. Pump A. Line Locate
B c ow Cert. Dace B. Valves B. Water Tower B. Line Locate
Re -Cert. Dace C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New Construction C Poor Installation D. Other
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6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
/ / /
R qu sc r Services: ,. -', - - (i• It , %,„ 1 - - -
/
f Meter, Service Leak: Classify: - City: Customer
40 A. W ater Loss (es ate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
oR I _ it IN C. Was Customer Notified: Verbally Doorknocker -
-a lid
Vehicle/Equipment Used
` �i f `•ie :er Caange G'_ :: Unit ; Miles Hrs Equipment
A. Old Mc::: - 231' g 5 - C' Reading -/ l7
0 3. New Mete: ? .5 /,2. — e/ Reading ce----
C. Old Meter SizeType: D New Meter Size.-Type
R E. Type of work performed or findings: 7; iJ L L ✓V e •5 e - •'
co
•
z a t 0 • :f saiaiine or deep service repair, describe type of pipe or service tine and condition:
x ,a.„
as
IA
1 1 . L:s: Ma :c:':als t_ se': c
le ,5 - 7 o "� ' . / e.s - 7 Ir 0o
11. (: - .. L 1a,± 1:2 lc_::_": _. ::evert ‘.s.hlle performing this Cequesc. Dtd you .e;cr: :t? Yes ::r :a
13. Water Utilities meter section: p or fail
14. How many trips to .a :ask?
�
s: 53 ^1C: