2000_0228 WATER
Issued: Finished: - ei ) C
Employee / Grid map: �t
Name: Address: 30 Je4 �O� View /eLJ C.[R
Phone Nu:rcer: (1-0,0 (WK):
Check for: A:curacy test: Meter Leak: Check water pressure:
Initial serer relocation inspections Re -read
1. Backflow• Gasp. 2. Repair 3. Maintenance 4. Other
Back low Insp. A. Main Line A. Pump ' A. Line Locate
Bklow Cr. e Dace B. Valves B. Water Tower B. Line Locate
Re-Cert. Dace 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: rn, 12 ({ f G At P 0 eti
7. If Meter, Service Leak: Classify: - City: Customer
A. W ater Loss (esti ate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
VehiclefEquipment used
3. If Mete:* Change Ow: Q ` /I I '?C1 z unit Miles Hrs Equipment
A. Ord Meter # U l 3 Readin l a l ) 1 7 2 (0 iq
3. New Meter # Reading
C. Old Meter Size.Ty e: D New Meter Sizenype
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Nfa. --:_.. I Hx5 Crew Me,rnhers. /
11. Lis: Ma:triais Used:
1?. If ;c -ad 1:1 accidencL-c :dent while performing this request. Did you report it? Yes or no
13. Water Utilities meter inspection: or fail
14. How .;.any trips to do ask? in Signature i ` Ci4