2000_0403 WATER 1
Issued: /0 Finished: a':3 00 Employee: - �`�,� Grid map:
Name: Address: / /'
Phone Number: (I-D t) (WK)
Check for: A curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backtlow Insp. 2. Repair 3. Maintenance 4. Other
Backlow Insp. A. Main Line A. Pump A. Line Locate
Bkflow Ctn. Date B. Valves B. Water Tower B. Line Locate
Re -Cep Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New 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 MereuService Leak: Classify: - City: Customer
A. Water Loss (esr.Wate): GPM Fire plug fl g Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/Equipment used
3. If Nfe :er Change Our: Unit 4 Miles Hrs Equipment
A. Od Meter T Reading
B. New Meter T Reading
C. Old Meter Size.T.pe: D New Meter Size/Type
E. Type of work performed or findings: /-I v - ao, ;s N: Al o
z
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Ala- ..._.. .S Crew Me:- :ers.
t
11. Lis: Ma:trials Used:
1 '. If ,u -an ar, ac ::dent . ::dent while performing this request. D:d you , por: :t? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How .:any trips to do ask?
Signature��