2000_0823 Ai to/ :,y"lC fag ...
WATER •
tssued: L -1_7 Finisbut: Etarb (71 / 7/ Grid m
s ame: :V A 15 0 2 s R G Pt i�'
o a / Address: l 3 2. / /a eti 1./ 4/(i z
Phone : her (FBI) . (WK):
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Check for _tunny :est: Meter Leak Check water pressure:
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Initial meter relocation iasee -_ions Re
1. Backilow Imo.. 2. Usk 3. Mainrciaaa 4. Nan
Back3ow Laser. A. Main Line A. Pump A. Line Locate
Be() w C::_ Dace B. Valves B. water Tower B. Line Locate
Re -Ce = Da :e C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
3. Reason for failure: A. Electrolysis B. New Coneu cdon C Poor lasodadee D. Other
6. List of safety apipmeet at site if applicable
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services: / /', M 4/ e 1 t A A)
7. If Me•te.: Service Leak Classify: - City: Customer
A. W ater Lou (mate): GPM Fite plug g Total Gallons
B. Wu water Meerut Yes No
C. Wu Custom= Notified: Verbally Doode ocker -
Ve iclerEquipo eat Used
3. If Me::: C :ge C.: t. it 4 Miles firs Equipment
A. C d }Ie:_. = q.7/ So WI Reading /77.3
3. New Me:e: = . • b Reading
C. Old Metter Siz ?e: lag s , 9d eft w deter Se J /
E. Type of wank performe • or findings: e !1 (, s ( d w R� .- i11
9. If sa= :: a or Veep ser'ce repair, descnbe type of pipe or service tine and condition:
�) .•(:- 2.,_S C:ra 6'.(
I ! . L:s: Ma:erais
2l? 4.- 77)
! i. is • _sip ... r.:._.-. _. : :de1c w :'e re ::c . this .e ;test. Dtd ;r,'.. -cr. .c? Yes .. :o
13. Wa:e:Iralires mete: 2syeetion: or fail
14. How =lay trips to A 'as'k? 3