2002_0827 WATER
Issued: glailoa, Finished: L Employee: Ra1110e Grid Map:
Name: i(YIIC la4 liftman (ur. fI 1I9 Address: 4Q4 Ua.IJ
Phone Number (I -Lvt): (WK): 11
Check For: Accuracy Test Meter Leak Check Water Pressure
Initial Meter Relocation Inspections Re -Read
1. Backflow Insp. 2. Repair 3. Maintenance 4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkflow 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: I l It - lea I (2
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
8. If Meter Change Out:
A. Old Meter # 14 I "J7 Z 1 2 Reading. (, -195 f 0
B. New Meter # Z3 2 O / 5 Reading
C. Old Meter Size / Type Ba 'e(' 5 Ax 3 Type % K /�
�4 New Meter Size / T e e
E. Type of work performed or findings:
9. It mainline or deep service repair, describe type of pipe or service line and condition:
10. Man hours: / 5 Crew members: / 1
11. List materials used: /hid ofatzr 1114.4/ � $ )10'�S -e fs -
12. If you had an accident incident while •- - • ming this request, did you report it? YES or NO
13. Water Utilities meter inspection: PASS or FAIL
14. How many trips to do task? / ...4 Z•
Signature