2002_0710 WATER
Issued: (1- it Oi Finished: ^ 7- A2--0 , Employee: Char �l'� Grid Map:
Name: DAL -9 JeCAC Address: (3 Lairds
Phone Number (HM): JJ (WK):
Check For: Accuracy Test Meter Leak Check Water Pressure
Initial Meter Relocation Inspections Re -Read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkflow Cert. Date B. Valves B. Water Tower B. Line Locate
Re -Cert. Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D. Excavation
E. Safety
5. Reason for Failure: A. Electrolysis B. New Construction C. Poor Installation D. Other
6, List of Safety Equipment at Site (if applicable):
A. Barricades B. Cones � C.. Tape D. Lights E. Other
REQUEST FOR SERVICES: SiLlt,1�. raf r•
7. If Meter / Service Leak, Classify: City Customer
A. Water Loss (estimate): GPM Fire Plug Flushing Total Gallons
B. Was Water Metered: YES NO
C. Was Customer Notified: VERBALLY DOORKNOCKER
8. If Meter Change Out:
A. Old Meter # Sl�$Is Reading CO 0O
B. New Meter # 0 2/ o 7 Reading O
C. Old Meter Size / Type 5 .4/443 - 44- New Meter Size / Type $1 N
E. Type of work performed or findings: - - N .=41 .v — "AI • • X,
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Man hours: . 5 Crew members: t,
11. List materials used: (- � X N�F
12. If you had an accident/incident while performing this re post -it® Fax Note 7671 Date p Pages■
13. Water Utilities meter inspection: PASS or 1 To my j4 � r ( From Dal I , RAiv ,
14. How many trips to do task? Co. /Dept. 1t-�l_ Q t 1 Co. LATI LU'��5
Phone # W 1 iC �J W l Phone #
Fax # Fax #