0326 WATER
Issued lLnished Employee t "t Grid map
Name: Address: ') / `)
Phone Number: (KM): (WX)
Time for water locate
Check for: Acc ncy . Wase taalc
Cbecic il►s:sr pcswo !Wild arMt etioeaetoa inpatioq_. Rrns1
1.Backflow rnsn. 2. genair 3.Naints1inct 4.4ther
Backflow snap. A.Ma,in Line A.Pusps A.Line Locate
B.Valves B.Kater Tower B.Iaspection
Bkflow Cert.Date C.Service Line C.Sesples C.Tap
Re -Cent. Date D- Rydrant _ D.squipmeat D.axcavation
a.Satety
S. Reason for failure: A. Electrolysis N. New construction C. Poor inatallatio
D. Other
6. List of safety equipment at site if applicable:
A. Barricades 1. Cones C. Tape D. Lights Z. other
west for Serviceman: 0/( /fit (
7.If Meter /Service Leak: Classify - City: Customer: _
A.water Loss (Esker.): GPM _ __ lire plug flushing _____ Total Gallons
3.was Water Metered: • Yes No
C.Vas Customer Notified: Verbally DOOMOCaR __
Vehicie/aquipment IIsed
$.Zf Meter Change oat: Unit # Niles Ste Equip
A.OLd Meter, 46-7L-11 c .. �' 7 ( Reading, a C,S�, _ ti} /1 / ( (
B. New Meter# 41 ) &. 2" 1 7 Reading O 1
•
C.01d Meter Size • '7tie � � � �'� r
/ZYPe • I � � �� � � /`'6 D. New Meter Size/Type (I 1, -> 1 , "/ %
E.Type of work performed or findings:
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Kanhours: , h - r. Crew members: 'Z_ -
LL.List Materials Used:
11.If you had an accident /incident while performing this request. Oid you report iv yea or nc
13.uatec Utilities meter Lnapecticn: pass or fail
LS.Hcv many trips to do task?