2000_0719 ,
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WATER ,
Issued: 9 /'f :niched: Employee: �� /t4 Gtr .
Name: 1. / _/. i , _mi _ Address: ice__ '�- _ 1
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c� (WIC): Phone N L� a .. .
Check for. A::curacy :at:. Meter Leak: Check water pressure:
Iniral sere: relocation inseeezoos Re -cad •
I. Back flow Inso. 2. &at 3. 4 . On
Backlow Lisp. A. Main Line A. Pump A. Line Locate
Bk.:low Cer. Dace B. Valves B. Water Tower B. Line Locate
Re -Ce = Dace C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
S. Rasoa for failure: A. Electrolysis B. Nov Coosuucdon C Poor Iustallatioa D. Other
6. List of safety equipment at doe if applicable
A. Barricades B. Cotes C. tape D. Lights E. Other
Request or Services: _ -.- . .'.■_! ' ,a L.i .4_ /
7. If Meter Service Leak Classify: - City: Customer
A. W ater Loss (es ate): GPM Fire plug flushing Total Gallons
B. Was Water Meese& Yes No
C. Was Customer Notified: verbally Dom -
Vehicle/Equipment Used
3. If `•:e :e: Change C'.:: Unit *Miles Fits Equipment
A. Old Me::: _ alas-7g c'7 Reading lky
3. New Mee: = 24 y / C iv Reading .e
C. Old Meter SizeType: biro D New Meter SizeType 7I4 Vii /70*-7
E. Type of wo& performed or findings: Jt w tl % e_ 7s'E
9. If 3 ii e or deep ierv;ce Nair, describe type of pipe or service line and condition:
V , / C:_•w Mer-::e :s. (7,,
1 1. L:s: Y.1 ::'a :s Used:
1'. l: ...11. 11 1C:. :_ . :dtmc '. h: a Vie: this :tquest. D d pr,..1 ;cr: c Yes 7r .0
13. W 1:er .: ciltres meter inspection: or fail /�
.o'er .:11 trips A *Ask? *Ask? /� /
l . Er Y s to p