2000_0612 ir) E e A 3 61 (---' -7-E- . ,
`` WATER
Issued: 1, _IA- bd Finished: /IL O° ° Employee: 6'4,e 7 Grid map:
cr
N a e : Address: / 9 05 /°, ' e) & 1.1,t l S j
Phone `.:.:tire"' (}4) (WK)
Check for Accuracy :est: Meter Leak: Check water pressure:
Inical mete: relocation in.we^_zons Re -read
1. Backrlow {nso. 2. &suit 3. Maintenance 4. Other
Back:low Lisp. A. Main Line A. Pump A. Line Locate
Bk:low Cer Dace B. Valves B. Water Tower B. Line Locate
Re -C: r Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
S. Reason for failure: A. Electrolysis B. New Construction C Poor Ikon D. Other
6. List of safety equipments site if appliab!e
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services:
7. If Me a Service Leal: Classify: - Ciry: Customer
A. Wirer Loss (es te): GPM Fire plug • g Total Gallons
B. Was Water Metered: Yes o
C. Was Customer Notified: Verbally Dootk>:ocker -
VehiclerEquipment Used
3. If Me::: C:ange 0 Unit 4 Miles Firs Equipment
A. O d Me:: = 2,2 6 354 G Reading 41')
3. New Mete: 4 2.6 ti2 !o `✓ ff Reading -)''
C. Old Meter Size ; pe: ...c -Vii "'loch D New Meter Siz_• tyre - c - AA 7/q ms's
E. Type of work performed or findings: W e i., e 4.46 -!,? e fe#2 le ' /' —e--
7e'( Grp '.- - 2. "c-c- - 1 c /t Y d ",- it
9. If aa=:i: a or deep service repair, describe type of pipe or service line and condition
10 `.(g-.: -,_.. L. -s C :_•.v M= -�e:s. /v i /"
11. L:s: `-11: :-as C.•se�:
h 1, CAA/ e 7e.( L, .,In - "-'e ." ri e 7r4 2- /� c 7 o/ co, - ,°, , f .
it , 70 , <<42 <e.-.s.5 e i /.!.;
1'. l: , .7.2,.: 1:1 1 :: : .::ctetc while per fcr rtln this .:atesc. Did /v.: . :c' .c' Yes •s .c
13. Wyer Utilities meter inspection: or fail
14. F{ow :r-tay trips to '_o :ask? 3 / �.
S : :la ^lr- } ' ^ ---1