0329 • WATER
rammed liniehed -- S) Zal Zmploye. 0Av . 't Grid map
Name: Address: , 4 h u n i ( 'rAr_ e:
Phone Number: (SN) : (n):
Time for Water locate
Check for: Aeeuesor wr Maear Laait Chowt.mmepromucc _1 tidal maeat eeiooaeioa ioopaetioq Rrmmi
1.eackflow tnsn. 2. guil 3.1iaintenaece 4.Other
Backflow insp._ A.Maia Line A.Pasps A.Line Locate
B.Valves B.Nater Tower B.Znspection
Bkflow Cert.Oate C.Service Line C.Saaplea C.Tap
• D.Rydrants D.Zquipsent D.Excavation
Re -Cert. Date E.Safety
S. Reason for failure: A. Electrolysis B. New construction C. Poor inatallatio:
D. Other
6. List of safety egaipsent at site if applicable:
A. Barricades B. Cones C. Tape D. Lights 1. other
Request for serviceman : 4 04 e a ye dk c 7" •
7
illk etsr /Service Leak: Classify - City: Customer: •
T
A.Water Loss 0516e m0: OM ?ire plug flushing Total Gallons
B.Was Water Metered: • Yes No
C.Was Customer Notified: Verbally ECIONZNOCIONt
• Vehicle/gquipmenat Used
$.If Meter Change Oat: Unit # Niles Ers Equip
A.01d Hater, '*1 5o O Reading /`r ' 7 7 252 O Z9c
8. New Meter# 7 - -- i_01.0 0 Reading 0 t
C.OLd Meter Sise /Zype: 2 12 019 S1 � D. New Meter sire /Sipe 5ItirneE � S
E.Type of work performed, or findings: ‘
9.1f mainline or deep service repair, describe type of pipe or service line and condition:
1a.Manhours: IN_ Crew members: - 2-
11.List Materials Used: t i i � .:.
12. re you had an accident /LncLdent while performing this request. OLd you report it? Yee or nc
13.uatec Utilities meter Lnepectlon: pass or fail
11.Hcw many trips to do task?