0331 •
WATER
Issued ILnished 5 ZLoYN Grid map
Nam.:
Address : Sze hen vrzS 23
Phone Numbier: (8K) : (WX)
Time for Water locate
Check for: mcwo t wt_. Ni Gras Clank now rum= Ta dd mar aio.adoe iR.ceio� tram
1.eackflow 2nso. 2. peoair, 3.
saektlow Insp.,__ A. o Line A. A.Line Lace
3.valves 1.1latsr Tower s. Zaspectio:
ekflow Cert.Date C.srvice Line c.sasples C.Tap •
Date 0.Iydzants 0.lgnipiseat D.Nxccavatiol
s.safety
S. Reason for failure: A. 'electrolysis B. New construction c. Poor inatallat
S. List of safety equipment at site if D. �
A. Barricades 8. Cones C. Tape D. Lights s Request for S rviceman: MJAlta- ✓�'le' - .1
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7.2f K.tezr /service Leak: Classify — City: Customer:
A.Water Loss c----» GPM lire plug flushing __ Total Gallons .
3.Was Water Metered: • Yes —__ No
C.Was Customer Notified: Verbally DOCZNNOcIZR __
Vebicle/squipmsat Need
1.1f N.tes Change Out: IInit # Miles firs Equip
A.OLd Mettrf £-S s '3 3 Reading I_ 4 9 y Z 9 ? O j9O
8.New Meter/ Z- 3Z ol Reading
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C.OLd Neter size /Type: 6 Ari ►1�,+��e S �Sl D. isw Mater Size/Type '� (ADZ f rz /6 Y K 5 .
8. Type of work performed or findings:
9.rf mainline or deep service repair, describe type of pipe or service Line and condition:
10.Haihours: 1'= Crew sambars: - 2-- - `.
LL.GLSt Matecists Used: L2' i I Pi'
11. L: you had an acctdent/LncLdent wh1Le p.rfor:anq this request. OLd you report Lt? Yes cr
13.wa:•c UtLLLtlee meter inspection: pass or faLL
LS•Hcw many tops co do task? _