2000_0302 WATER
Issued: Finished:3 Employee: M e /�D Grid map:
Name: Address: 4P J a 3 m es$0, li (� C) C)
Phone Number: (HM) (WK): V
Check for: A.:curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bk:low Cert. 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: T z4 2 )( h Ck s12 C U
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 Meer Change Out: unit 4 Miles Hrs Equipment
A. Old Meter 4 1 '/f; 0i 7 Reading) �('O 1 11 7 cxtbolq 6
B. New Meter .4 2- (o 1 1 (9 1 5' Reading e�
C. Old Meter Size-Type: '5/03 Arc -e7� D New Meter SizerType,s' /r
E. Type of work performed or findinos.
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. j/9.. Crew Meg.. :ers. l
11. List Ma:criais Used:
1?. If you : ^ac i i is :idenci. -::dent while performing this request. Did you report t? Yes or no
13. Water Utilities meter inspection: p .2 or fail
14. How ,:.any trips to do task?
Signature R, 1/1„ k0 L\