336 Gifford WATER
• Issued Tin.. sd , Employee U f Grid strap
Name: - Address: i 3 & C$ Ad
?hone Number: (8M): (WX):,
Time for Water locate
Check for: Aeau+r, mac_ Mesa Laalc Cback rater peemwm _ Initial toga nlocatioa im sc _ Raquel
1.Backflow Insv. 2. MALL 3.Maintenance 4.Oth.r
Baekflow Insp., A.Hain Line A.Pumps A.Lins Locate
B.Valves B.Water Tower B.Inapection
Bk_low Cert.Date C.Service Line C. Samples C.Tap
D.Hydrants D.Equipment D.Excavation
Re - Cent. Date E.Safety
Reason for failure: A. Electrolysis B. New construction C. Poor installation
'. construction D. Other
O. List of safety equipment at sits if applicable:
A. Barricades 3. Canes C. Tape D. Lights E. Other
Request for Servicetman: Vin 4,t(- -I-.). Q k
7.:f Meter/Service Leak: Classify — City: Customer: _____,_
A.Water Loss (Fs6t::ata2: GPM ?ire plug flushing Total Gallons
S.Was Water Metered: Yes No _—
_. Was Customer Notified: Verbally DOORXECCIOCZ
Vehicle/Equipment Used t
3.I1 Meter Change l Ouut: Unit # Miles firs Equip
;.Old Mozart p3 /J 6 ;5 . Reading a7 93..„,___91
3. New Meter # 9-1;
Reading o
/
^.Old Meter Si.e /'Tyge: S /�' , 0 .... -D: •-flew Meier S -ize /Type ' , /� �i -
..
E.Type of work performed or findings: 1
3 ,4 T4
ekv7i. 0..A "1 AVista A 4.44 xiii L..' ktA , 4.7 4 AfeC
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.4anhours: , / Crew members. '
LI.List Materials Used:
12.2f you had an accident /incident while performing this request. Did you report it? yes GC no
13.Waeer Utilities meter inspection: pass or fail
14.8ow many trips to do task? - '
S ignat e