2000_0214 WATER
Issued: Finished:.2 — /y- &C Employee: in n e /*' _ Grid map:
Name: Address: 7/2 fn ui Yk r S
Phone Number. (PPM) (WK):
Check for: A:curacy test: Meter Leak: Cb ° ° water pressure'
Initial meter relocation inspections P c read
1. Backflow Insp. 2. Repair 3. Main.r;r:ynce 4. Other
Backflow Insp. A. Main Line A. Fu ,p A. Line Locate
Bkflow Ctn. Date B. Valves B. Water Tower B. Line Locate
Re -Cep Date C. Service Line C. Sarnoles C. Tap
D. Hydrants D. Eqp. D Excavation
E. Sa.f ty
5. Reason for failure: A. Electrolysis B. New Construction C Poor L:.Estallation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Light Other
Request for Services: ,r1.. - 7 e't (q G )e '3 fJl
7. If Meter /Service Leak: Classify: - City: Customex
A. Water Loss (esr:nzate): GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/Equipment used
8. If Meter Change Out: �/ �y # Miles Hrs Equipment
A. Old Meter 4 8‘0030 D Reading 3I ;2 p /I 3 .O bO /0
B. New Meter # 2 ( °i tsar or Reading
C. Old Meter Size T pe: D New Meter
E. Type of work performed or findings:
9. If mainline or deep service repair, describe type of pipe or service lip w ♦ nd condition:
O. Ma: ..: 1 H/6 Crew Me...h-rs.
11. List Matena'.s Used:
1?. If you had an accidentL :dent while performing this request. Did you report :t? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How r .aay trips to do task.?
1 /1 Signature t {� t.