2000_0302 WATER
Issued: Finished: Z"C Employee: ivtf_' /S O Grid map:
Name: Address: JO t / 1 ) C l.(1 LA, 'o 8
Phone Number: (1-LM) (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
Backflow Lisp. A. Main Line A. Pump A. Line Locate
Bkflow Cep Date 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 c ii c ti'�� r 44 —
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 -
VehiclerEquipment used
3. If Meter Caange Out: Unit 4 Miles Hrs Equipment
A. Old Meter 4 72 63 Reading 1 7`1, // 7 � �CO17d
B. New Meter 7 , �I b 2 Y Reading Jr
C. Old Meter Size.Type: UA P2 - /C D New Meter SizeiType 5f 7/9.� 1,Z
E. Type of work performed or endings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
O. Ntaz- -c-- -. � "1/145 Crew Me,..Oers. /
11. List Ma :er:ais Used:
13. [f you :^ad a1 accident:. while performing this request. D:d you repar. it? Yes or no
13. Water Utilities meter irsrection: LO6ss or fail
14. How .:.any trips to do ask?
P 4 / 1 / 4;
Signature / /G_`