2000_0915 •
W*
Issued: - : ai:bet i f oa
Sa=e: 11/ . "�_-, _ Address: - .`
/ulnae `_r::ier: IAMrm ?'
check or Accuracy : deter Leak Check grater pcessiue:
laical racer iiloacoa inspections Re call
1. $acct tow (ol. 2. Unit 3. Mainal+s 3. Rib[
Ballow [asp. A. Main Line A. Pump A. Lies Lome
Bk:'.ow Cert. Dace B. Valves B. Water Tower B. Line Locate
Date C. Service Line C. Samples G Tap
D. Hydrants D. Equipment D Excavation
E. Safety
S. Reason for fttlarc A. Electrolysis B. Nes Coessuctios C Poor hasseados D. Other
6 . List of satiety egaipares s slues if applicable .
A. Barricades B. Canes C Tape D. Lights E. Other
R . - c for Services: -' - //' ,r/ ,/ /� _ ' . –
7. if `Ir-r Service Lut Classify: - City: Customer
A. Water Lou (te): GPM Fire plug Hashing Total Galleons
B. Was Waterer Yes No
C. Wu Ca c Notified: verbally Doaiaodcer -
Vei:ieiaEquipment Used
3. t ` .t. :: ; =a.:ge C :_ tcir 4 Mks Firs Equipment
A. C - 16L-S O 7 Reading /11
3. New M e - e : ? r' ' ' ' Riding
C. Old Meter S :;•fie: t" :, 4 • c-r D New `meter Siv.t yge 4 /$4 1/Y /4.4
E. Type of t ?o •• • or findings:
9. or tee: z- '- : ::e?air, describe type of pipe or ser' ce titre and condition
L ....... :; � C :.•»
I
/- r fi t ?
:: :t- ;,e :'c.::tirtg this .:: D:d .:c- :c:' Yes ..:c
13. 'W3: :: Latuties re.:: rs;ecciott: pus or fait
l t. HOW .:1ty trips A Yu'
` awe