2002_0713 WATER
Issued: 7 - 13 - O a. Finished: '7 -/3 -OZ. Employee: , Grid Map:
Name: Address: 6.2fc /J,44,71C.
Phone Number (HM): (WK): L 1l =-AP ( 9/4--(17, —1941
Check For Accuracy Test Meter Leak Check Water Pressure
Initial Meter Relocation Inspections Re -Read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Qtat
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: to A -F CD Alf )17 e, -f- bp.-410-)M t9-F
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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 # i913 .23 .3 Reading 3,a.A6 t)
B. New Meter .t fog 151 Reading t�
C. Old Meter Size / Type 5 4 Pete t itoa New Meter Size / Type - 'x P445 "1212..
E. Type of work performed or findings: Ko vlAri jt, - -is - TL c/' 01 q e &'fs Ilefcv Gcti4/e.c-
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9. If mainline or deep service reps::, describe type of pipe or service line and condition: t■ w
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10. Man hours: Crew members: g
1 1. List materials used: l" E
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12. If you had an accident; incident while performing this request, did you report it? or -z
13. Water Utilities meter inspection: PASS or FAIL
14. How many trips to do task? z $ flc
Signature
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