2000_1101 /V ei iiti pi L , „ - 7 - e- - 'V
WATER
Luued: //.) - 0 Finished 11 -1 -00 Employee: , G 4 r' 11 Grid map:
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None: Address: t S` 6 F,r� rt'2' cv r � U
Phone Number. (FLT() (WK):
Check for. Accuracy test Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow Insp. 2. impair 3. Maintenance 4. Our
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkflow Cert Date B. Valves B. Water Tower B. Line Locate
Re -Cert. Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. Nov Construction C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services:
7. If Meter /Service Leak: Classify: - City: Customer
A. Water Loss (estimate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorlmocker -
Vehicle/Equipment Used
8. If Meter Change Out Unit # Miles Hrs Equipment
A. Old Meter # 5" 47 13 L-5 Reading '722,3
B. New Meter # 2 (e `/1 7 0 C Reading er
C. Old Meter Size:Type: )7?„1 ; /.., ,4 f i D New Meter Size/Type s/b J /y" ,'l
E. Type of work performed or findings: L ' 4'1.'.2 j 6 a l).1 r A' 14..L 7r 4
6dG %1
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Man -hours: ,/ . 0 Crew Members. 6" /'()
11. List Materials Used:
✓v d - 4 e,--7 iii
1 2. If you had an iccidentIacident while performin 's request. Did you report it? Yes or no
13. Water Utilities meter inspection: p or fail
14. How many tri to do tuk? /
Signatu