2000_0724 ivcAAY • e
WATER
Issued: •) - Z `'1 r`•,nuiaed: 7 - dtf' do Employ= 6 4 r y Grid map:
v arwe: Address. / LS- - /f € A a T 2-
Phone `s.:.ce -.. (KM) (WIQ
Check for k :urxy :u• Meter Leak: Check water pressure:
Initial =tier relocation inspecdoas Re -read
1. Dacktlow rasp, 2. &lac 3. Mainxmncs 4. Qlba
Back:Zow Insp. A. Main Line A. Pump A. Line Locate
B;c:To� Ce t Dace B. Valves B. Water Tower B. Lime Locate
Re -Ce : Dare C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavatioa
E. Safety
5. Reason for failure: A. Electrolysis B. ,New Coasttuctioa C Poor Insofiadon D. Other
6. List of safety equipment at site if appKpbiir
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services:
7. If Mertz Service Laic Classify: - City: Customer
A. W carer Loss (este): GPM Fire plug flushing Total Gallons
B. Was Water Meeerted Yes No
C. Was Custos.ff Notified: Verbally Doo knoct r -
Vehic?erEquiptnent Used
3. if `de : :- Change C' Unit 4 `tiles Hrs Equipment
A. Me:er = 46---'! y 3d / S ✓ -Reading i$''
3. New Mete: '4 2_(/ '/Z b '7 '7 Reading C
C. Old Meter SizeT jpe: ' 7 P se 3/y ,f3 Ally -r r D New Meter Size Type '/8 Xe4
E. Type of work performed or findings: 01/1 v✓ c 7
9. If Ta=!:re or deep ierrce repair, describe type of pipe or service line and condition:
i') .•!i- - ,
LC C :e•.r Me...ce:s.
l I. L:s: `.li: : -ais
•.'h:Ie re: fcr-rtistg this :equ_sc. Old 'r,.. :cr..c'. Yes ..:o
13. «'a :e: L edicts crere: Lspection: r fail
14. How .:1:y ctps !o ...la zsk'
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