0329 WATER
Zsewd finished 3 / 2 bsplaye� Crld map
xama: Address: 3 ) /
Phone Number: (BA) :
(WX):
Time for Water locate
Check for: Ammar,toc_. Weser taak__. Quick waxer pets filial arise mioudeaiq . e ..
1.3ackflow rnsa.
2. jteoair 3 •laid! {.
sackflow rasp._ A.Kaia tine
s.Valves s.ra� Tower a;tz Lacs
Bkflow Cert.Date C.Service Line C.Sasples C.Tap
Re -Cart. Date D.Bydrants 0.=quipmsnt D.Excavatio:
:.Safety
S. Reason for failure: A. Electrolysis B. New eoastructioa C. Poor iastallat.
S. List of safety equipment at site if applicable: O. Other
A. Barricades 1. Cods C. Taps D. s. Other
Request for Serviceman: , (A) (�- Cp+2 � - (' i 1 n� r
7.rf Xetpr /Service Leak: Classify - City: _ Customer: •
A.Water Loss (Fs;.m): GPM lire plug flushing Total Gallons .
B.Was Water Metered: • %es _____ No
C.Was Cu Notified: Verbally DOO OCZER __
• Vehicle/Equipe:int Used
i.rf Deter Change Oat: Unit # Miles firs Equip
A.OLd Mater# <(' 1- Z-- Reading 70 7 "a1702_9
B.xew xeters 73 )1 9 Reading (")
•
C.OLd Neter Sims /Type:, P2- C 51 � � \(1hp cC,v D. New Meter Sirs /Type T UI( 5�2 � �
E.Type of work performed or findings:
9.Lf mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: .j 2 Crew members: Z_
LL.Gist Materials Used: e? '
11.t! you had an accident /Lnctdent whlllf_pertotatLng this request. Otd you repot% Ltt yes or
13.s+::er UtLLLtLee ester LnepectLo:t: 94S cc fall
LS.Hcw many tripe to do task?