2000_0214 L is T - 7
WATER
Issued: Finished: � "'ticnploye /1/ � Grid map:
Name: Address: 71/ /-)7e 2 e c L i 4
Phone Number: (HM) (WK):
Check for: A :curacy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Other
Backflow L1sn. A. Main Line A. Pump A. Line Locate
Bktlow 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: 11 e N o 11
7. If MeterService Leak: Classify: - City: Customer
A. Water Loss (escalate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. W35 Customer Notified: Verbally Doorknocker -
Vehicle/Equipment used
3. If Meter Change Ow: Unit 4 Miles Hrs Equipment
A. O d Meet ; n 713 C C5 Readinga / G3 1 f S � 6
3. New Meter 4 Z , • Reading
C. Old Meter Size :Type: pe: £ •. :, Y D New Meter Size:Type37 (4/957t - e.
E. Type of work performed or findin
9. If mainline or deep service repair, describe type of pipe or service line and condition
11. List Mate -a ?s Used:
Post -i4 ax Note 7671 Date Qf pa°ges
Co. /De j , , o. '
��A�
fi 1 r M Phone #
13. If ^.0 '1� la lade: �//
Fax #
13. Water Utilities mete!
14. How .:any trips to do ask? S'
Si3nature ke 7/(elt