0329 •
WATER
Issued finished Z Etsploye. ,__L.,); Grid map
Names: Address: .4 Rn. 4 ,
Phone Number: (sli) : O
• III
Tim* for Watsr Locate
Check for: Aw uz rwt__ Nazar Leak_. Choek vats: penaxs: fried srse mesa iea i4.eeoq__ Las
1.8ackflow Ins:. . a. J.nair 3.
sackflow Insp. A.tea Lino Cahn Cahn __
s.Valves s.Nat Tower 3. Lora
ekflow Cert.Date C.Service Lino C.Saaples C.Tap
• Re -Cent. Date 0.lydraats 0.iquipmeat D.excavatio
!.safety
S. Reason for failure: A. electrolysis B. New construction C. Poor ittstallat_
D. Other
t. List of safety equipment at site if applicable:
A. Barricades 1. Correa C. Tape D. E. Other
Request for Serviceman: 141 `fe. (2 )e (pry �3 U e
•
7.If Meter /Service Leak: Classify - City: _ Customer: __r__
assets: Loss (F.t.): CPN Vire plug flushing __ Total Gallons ___ .
B.sas Nater Metered: • Yes No ....__
C.Vas Ct;stomer Notified: Verbally DOONKNOCiiR
VehioleilgoipmsnAita `
i.If Meter Change Out
at: trait # Niles lirs Equip
A.Old Mater, 7 /nol `1 Reading )q47 9 y ` Z 70Z90
8. New Motor, 3 z-37 ` C( Reading_ b
1
C.Old Neter Size /Type: ! f4' Y1le4v _ Sig o. New Meter Size /Type ( VYJc°! e 5)
E.Type of work performed or findings:
9.Lf mainline or deep service repair, describe type of pipe or service Lute and condition:
1a.Hacihours: '11 Crew members: Z `.
1L.GLit Mateciats Used: �i._�. ' IvL ,..
_____k
12.C! you had an accident /LncLdent while performing this request. Gad you report Lt1 Yes or
13.wa:•c CJtLLLcles eetec Lnapecticn• pass or fiat
LI.Ncw many tripe co do task? _