1999_0505 pp WATER
Issued — Finished 5. `, �j l -I Employee 348 Grid map
Name: Address: I I V '4 d
?hone Number: (H24) : (WK): / .
Time for Water locate
Check for: Accuracy tsar_ Meter Leak: Cleck water immure: Initial meter relocation inspecoo _ Re - rtad _
1.Backflow Inst. 2. Repair 3.Haintenance `.Other
Backflow Insp. A.Main Line A.Pumps A.Line Locate
9.Valves B.Water Tower B.Inspection
Bkfiow Cert.Date C.Service Line C.Samples C.Tap
D.Hydrants D.Equipment D.Excavation
Re -Cert. Date E.Safety
S. Reason 'cc. failure: A. Electrolysis B. New construction C. Poor installation.
D. Other
o. List of safety equient at site if applicable:
A. Barricades 3. Cones C. Tape D. Lights E. Other
Bequest for Serviceman: /J//eR /peter iiiiitlyg Ma _
Meter /Service Leak: Classify - City: Customer:
A. Water Loss Mail:mut: GPM Fire plug f lushing Total Gallons
3.Was Water Metered: Yes __ No
C.was Customer Notified: Verbally DOORENOCICER
Vehicle /Equipment Used
3.7.1! Meter Change Out: r) Unit # Miles Hrs Equip
A. Old Meter# R1/A56$ l p / Reading �® /(3Xk // I q,2 0E ()
3. New Meter # a 6 3 /57, 5 Reading
C.Old Meter Site /Type: 1::Ct arie 44 D. New Meter Size /Type IthL,Z "T'K 5 "r
I.Type of work performed or findings:
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Hanhours: ' Crew members: ___)
L1.List Materials Used:
12.If you had an accident /incident while performing this request. Did you report it? yes or no
13.Water Utilities meter inspection: p or fail 1 3,06
14.How many trips to do task?
Sianacure _