2000_0228 WATER
Issued:
Finished: Employee: /)1--/ 2.: <5 Grid map:
Name: Address: G £' t(// / 1 / -
Phone Nu,T.Cer: (FD't) (WK):
Check for: Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspectioas Re -read
1. Backrlow Insp. 2. Repair 3. Maintenance 4. Other
Back low L-tsp. A. Main Line A. Pump A. Line Locate
Bk:iow Ce- Date B. Valves B. Water Tower B. Line Locate
Re -C.n 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: 11/e k. ( r I) F� Y� } 77/ (t--
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 Doorknocker -
VehiclefEquipment used
3. If M.:.7 Caange Out: unit 4 Miles Hrs Equipment
A. O d Meter ��(;'�ri �^ Reading .3 1 1/ 7 (7,0 J is
B. New Meter 4 ;-- fi / H 1 Reading
C. Old Meter Size- Tyne: 5AsS A;.3dti,cR D New Meter SizerType' f Yj
E. Type of work performed or findings.
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. tifa ^- '� :_.. Crew McThers.
11. Lis: Ma:e::als Used:
P. (f :cu : ^ad an accident,:. while performing this request. Did you re ;cr. it? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How r:.a.iy trips to do ask?
I /6 e `
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Signature /7