0330 WATER
Issued rir ishad / ;. reaployee ( / /5F Fj Grid map
Name:
Address: })
Phone Number: (m: (W1C) :
Time for water locate
Check for: mangy um_ Weer Leak Cheek wear mum: taio.t moue atoeuioe irq.ctioq__ Una/
1. eackflow rnsn. 2. genair 3.Maiatsnanes 4.21hr
Backflow Insp._ A.Maia Line A.Pumps A.Line Locate
B.Valves 8.Water Tower B.rnspectioon
Ski low Cart .Date C. Service Line C. Samples C.Tap
• D.Eydrants D.Egnipmsat D.Excavation
Re -Cent. Date E.Safety
S. Reason for failure: A. Electrolysis 8. New construction C. Poor installatio
6. List of safety equipment at site if applicable: D. other
A. Barricades B. Canals C. Tape D. Lights R. Other
Request for Sortie:Nan: Y t t2
7.If Meter /Service Leak: Classify - City: Customer: - •
A.water Loss (82e2w): GPM Firs plug flushing __ Total Gallons
8.Was Water Metered: • Yes _ Eo
C.Was Customer Notified: Verbally DOOEOCiiR
Vehicle/lig:ipsent Used
•.If Neter Change oat: Unit # Miles Ere Equip
A.01d Meter# (I I L`r' L Readin 7/// � � <" r 2( (;
S . New Meter/ l (, � !Cl Reading C;
C.OId Meter Size /Type: i E 21 1 , D. New Mater Size /Type 411 *:?/ 0.' i, 144a
Z.Typs of work performed or findings:
9.tf mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: t/ Crew members: `.
1I.Giat Materials Used: �:� �dy -
13. LC you had an accident /incident while performing this request. Oid you report Ltl yes or nc
13.s{ater Utilities meter inspection: pass or fail.
14.Hcw many trips to do task/ ,h►