0000_0710 •
WATER
Issued: 7-/ Finished: // Easpbyee 67 1 , f/ Di4 Avr end m
Nate: Address: 2_0 2 11/c.,0 / a.✓■ e i
P hone `:.r..cer- (FD.O (w1C):
Check roc Acn. incy :es:: Meter Leak: Check water pressure: •
Initial meter relocation ias$eedoas Re -read
1. Hacktlow asp, 2. Email 3. Mainoemnce 4. Qthg
Back:Tow Lisp. A. Main Line A. Pump A. Lime Locate
Bk low Ce = Dace B. Valves B. Water Tower B. Live Locate
Re -Cen. Dare C. Service Lute C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
3. Reason for fall= A. Electrolysis B. .New Consuuctioa C Poor Installation D. Other
•
6. List of safety equipment *site if applicabhe
A. Barricades B. Cones C. Tape D. Lights E Other
Request for Services:
7. If Meter:Serrice Leak: Classify: - City: Customer
A. W ater Loss (es ite): GPM Fwe plug • Total Gallons
B. Was Water Metered= Yes
C. Was Customer Notified: Verbally Doodmodcer -
VehiclerEquipment Used
3. If `!.:_- C_aageC'... Unit 4 Miles HrsEquipment
A. Old ate: -. =( &S 3 Yyg flReadiag 2. 6 (o -3q
3. New Mee:* Z 6 6 12 b 2. Reading -4`
C. Old Meter Siz .Type: s7t x V.( /3 4 ? D New deter Siz_ i•/re >78 .. 3/.' t`r,'l
E. Type of wodc performed or findings: Nc r✓ r c %c z — Nev
, 'lite6604z r P01,1/
9. Ii sa_!i a or de:p service repair, describe type of pipe or service line and condition:
11 _2_, /) P
I. L:s: `•(3::-a:s Lse •
A- P "1/ /Z es AA/ e- - e
l,. (f r e: °cC :ling this .:: Did v:.. ;c .c' `!_s :o
13. Ws::: L mires mete: erection: or fail
14. How .:.a.:y nips to .o asY' 3