0329 WATER
rseued finished _ to ee
=mp y ,A901 ) Grid Grid map
Name: Address: /1 7 iI 7/
Phone Number: (ffii) : , (WE):
Time for Water Locate
Check for: Accuser rear_,,, Mane task Chuck water pressure: facial mow aura doe ieepecm4._ Zeitted
1.Backflow Tem. 2. gei:air 3.Mainte
Backflow Insp. k.Nai:i Liao A.Pumps A.Liae Locate
3.Valves B.Water Tower B.Insp.ction
• Hkflow Cert.Date C.S.rvice Lino C.Sasples C.Tap
Re -Corr. Date • D.3ydrants D.Equipment D.Excavation
E.Safety
S. Reason for failure: A. Electrolysis H. New construction C. Poor installatio:
D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Servicssan: fAiQ t2 /11e42._ ( &-Gt
7.if Meter /Service Leak: Classify — City: Customer:
A.Water Loss (Fmcienn): GPM Eire plug flushing __ Total Gallons _ _
H.Was Water Metered: - Tes _____ No
C.Was Customer Notified: Verbally Docutiosocisse ___
Vehicle /Equipment Used
$.If Meter Change Out: Qnit # Niles Era Equip
A.014 Meter# q 1 - A t6 O iiS Reading ° l (ea (te Z9 _ �O
IL Mew Meter# -7- 0 ,q ) Reading
C.OId Neter Sine /Type: . - = ,, D. New Netsr Site /Type /'t s e w e
E.Type of work performed or findings:
9.If mainline or deep service repair, describe type of pipe or service line and condition:
1O.Manhours: 'Iz- Crew members: -
• r
1L.List Materials Used: ``j
12. you had an accident /incident while performing this request. Old you report Ltt yes or nc
1i.uatec CJtilLtLes meter inspection: pass or fail
L1.Hcw many trips to do task?