0329 WATER
issued Finished 5 1 Z4 !'espley.. beD b Grid map
ame: Address: /2:5' h,7/
Phone Number: (PM): (yam):
Time for Water locate
Check for: Accuracy tar_ btwe Leak Cheek enter mime kids! maw tolocatka _etioq� Ra
1.8aekflow Inca. 2. "eclair 3.Kaintenanee 4.Snase
3ackflow Insp. A.Kairs Liao A.Pu.ps A.Line Locate
B.Valves B.Mater Tower B.Saspection
ekflow Cart .Oate C.Service Line C.Sasples C.Tap
• O.Sydrants D.Equipment D.Excavation
Re -Cart. Date E.Satety
S. Reason for failure: A. Electrolysis 8. New construction C. Poor installation
D. Other
6. List of safety equipment at site if applicable:
A. Barricades 3. Cow s C. Tape D. ghts E. Other
"
Request for Serviceman: !l `t f:�2 ���Y . ckAn
7.If Keter /Service Leak: Classify - City: Customer: •
TTY
A. Water Loss (mss): GPX , Tire plug flushing Total. Gallons -
B.Wu Water Metered: • Yes
C.Was Customer uotitied: Verbally 00013310CEER __
Vehicle/Equipment Used
t.If Meter Change Out: - Unit # Miles Ira Equip
A. OLd meter# ° = e • - -•,;, Reading / `/C ( 1 2 9 9 OZ 90
8.New meter/ 7 O1 Z Reading
•
C.OLd Meter Size /Type : 6Nd9e(L �`��2
' UUU ` D. )few mater Sise /Type �5 JF1 72 --- 1 ( 7 ° - 44., S G �(
E.Type of work performed or findings:
9.If mainline or deep service repair, describe type of pipe or service Line and condition:
10.manhours: \11i Crew members: - `.
11.Giet Materials Used:
12. LC you had an accident /incident while performing this request- Old you report it? yes Cr nc
13.Watec Utilities meter inspection: pass or fail
1.1.Hcw many trips to do task/