2000_0302 WATER
Issued: , Finished: — Co Employee: r r-.L f Ccl) Grid map:
Name: Address: /GI f e Si i 1( 4-tf_ u ),,'z=,'
Phone Nu, ^her. (1-LM) (WK): (.)
Check for: . :curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkrlow C. Dare B. Valves B. Water Tower B. Line Locate
Re-Cert. 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: ni E E R 0.1 Cr -n V e (! l,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 -
Vehicle/Equipment used
3. If Meter ange Out: Unit 7 Miles Hrs Equipment
A. O d Meter # 1 3 ISO i 1 I Reading 10 G fr / 7 1/ 7 : _ ; 2 . . . b - 6 ,
B. New Meter T 3, 6 it i (c }. Reading 75 r -
C. Old Meter Size.T i%3,4 E < D New Meter SizeiType %, /, /F)3 - eK.
E. Type of work performed or findi
9. If mainline or deep service repair, describe type of pipe or service line and condition:
jWK? /
10. Ntaa- ::-c_ :. Crew Me:rhe :s.
11. List N[aarials Used:
1 ? . [ f you an accidenC ::.::dent while performing this request. Did you repor. it? Yes or no
13. Water Utilities meter ins ection: cp or fail
14. How many trips to do ask?
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Signature '/( ; C)A t