2002_0408 WATER
Issued: gi' 816 L Finished: I- 6Z Employee: Grid map:
Name: Address: MI IP 644_411D tvt e "u0d c.:
Phone Number. (HM) (WK):
Check for. Accuracy test Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow Insp. 2. bask 3. Maintenance 4. Q
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: P1 Pt C fiiA -Aici e OLrr
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 -
Vehicle/Equipment Used
8. If Meter Change Out: Unit # Miles Hrs Equipment
A. Old Meter # 9D5 W / Reading
B. New Meter # 03 )0P0 Z. Reading /i GOO
C. Old Meter Size/ Type: g - a6 16.ti D New Meter Size/ Type M AM
E. Type of work performed or findings:
CA
9. If mainline or deep service repair, describe type of pipe or service line and condition:
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C 1111 4
10. Man - hours: Crew Members. q
11. List Materials Used: o N
12. If you had an accident/incident while performing this request. Did you report it? Yes or no
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13. Water Utilities meter inspection: pass or fail z °
x
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14. How many trips to do task?
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Signature rP7n Ul3 a