2000_1120 /tie 4/ /'S G -- 7 _ . .
.
[sued: / /� • WA'TE _
/ Emipio
races //,'at,c_ �, - - � � - . _.�. - - --
Check cot. Accuracy • _ Meter Leak Cluck yes pressure:
laical .:sets• reload= iasee=i+oess Re,cead •
1.8te3Ltaw iass. 2- Basil 3. iia 4.
81c130 Gasp. A. Maier Line A. Pump ' A. Liss Losers
Beau, Cert. Due B. Valves B. Water Toys. B. Lime Loeate
Be-Cert. Dam C. Service Line C. Simples C. Tap
D. Hydrants D. Equipment 0 Excavation •.
E Safety
S. Iteesoa foe ea= A. ELeeuatysis B. New Coestecdm. C Poet boolledese A OW
6. List daft mimes* lee if applicable
A. / B � azri des B. Comes � C. l Tape D. Lippe: E Other Other . J `/
Request for Se (
7 [ �i't2<.e f 3 -,'.f ,t" / 'Y ,J kit /1 / /A2--62---4-- --
tic
.e_
If Me Servic Lake Classify: - City: Cum=
A. W uer Loss (): GPVC Fire pin Mashing Tool Gallons
B. Was Wa alfrua t Yes No
C. Wu Caere; `odSed: Verbally Doarlmodar -
Vehi,ciaEquiprtuttt Used
3. C: .`..f.::::- .:.L:;: '>::: Cdt 4 Ales Fps Eq :iptreac
•
_..its :M :._. ..f2 Reading S
3. Nei Mr-e: = .j /, v 2 )z 9 R=diag 0
C. Old `{r- 3i:Type : % / , 0 Near Meter S'¢:Tye - %/ r
E. Type of weer per otnzed or C u : d i n g s : , o i ' l N A i Z 4 / ' 7 i 77 / /- 2 /-456
9. I:. .1_ :::: :r '.er ,C! N air, describe type or pipe or sr. ice time zed coedicae:
;.) ...... _. / ,r C : :•y N(e- • :e :s. 6-A_ J/-/
(! .: ;: ` :3::-.1 :c�
I . :3.: L: 2:: _ :... _ : :.1.::t: "A' pe ::c.:.uctg this :.lei:. ?:C :' -c' .c? `!:s :c
l 3. 'ire: LRlir'es T.C« reeciort: pass or fail
14. E?z'y .:l :( nips a a ye