2000_0306 WATER
Issued: Finished: �' �``� Employee: ���� /�C' Grid snap:
Name: Address: f .-7 fl1 F ; (4'U i4— to `ycfi 0
Phone Numcer: (FD4) (WK)
Check for:A:curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. $ackrlow Insp. 2. Repair 3. Maintenance 4. Other
Backlow Lnsp. A. Main Line A. Pump A. Line Locate
B :k:low• Cr. e Date B. Valves B. Water Tower B. Line Locate
Re -Cer_ 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: 0 4 , 70? - 1 E' iZ
7. If Meter, Service Leak: Classify: - City: Customer
A. Water Loss (estate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
VehicleEquipment Used
3. If Meer Change Out: Unit te Miles Hrs Equipment
A.Od Meter # � 5t. 1 13 5 (e+ 1,' 7 2�(r,cigd
3. New Meter T (c 1- 1 f ( Reading
C. Old Meter Siz:.Ty e: 5/e 67-) 4 D New Meter SizeiType
E. Type of work performed or findings/.
9. If rraialine or deep service repair, describe type of pipe or service line and condition:
l0. Ala- .._ _-. 1 Crew Nier : ±e :s. 1
11. Lis: `•l3:_r als L'sed:
1?. [f. :u:ad an ac: :den::: ::dent while performing this request. DLd you :pct: it? Yes or no
13. Water Utilities meter inspection: criTs) or fail
14. How .:any trips to do ask?
C1�
Signature -