Loading...
1997_1210 WATER Issued � �,/�� - i 7 Fini shed Employee /M/ l <- 944a1/1r imp map Name: Address: (O J / Si impie I5 ?hone Number: (HM): (WK): Time for Water locate Check for: Accuracy test: Meter Leak: Check water pressure: Initial meter relocation inspection Re-read 1.Backflow Insp. 2. Repair 3.Maintenance 4.Other Backflow Insp. A.Main Line A.Pumps A.Line Locate B.Valves B.Water Tower B.Inspection Bkflow Cert.Date C.Service Line C.Samples C.Tap D.Hydrants D.Equipment D.Excavation Re -Cert. Date 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 Q Request for Serviceman: C //Q - C. / � f - C4._ � # / p ©/ �} ` g' 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 DOOR NOCRER Vehicle /Equipment Used 8.If Meter Change Out: �/ Unit # Miles Hrs Equip a. Old Meter/ / n 0 / ?if? ? Reading B. New Meter/ el 9S924$36 o Reading 0 C.Old Meter Size /Type:s rY ,6 / D. New Meter Size /Type E.Type of work performed or findings: C Arafy.f 0 tcr /1.1 -4/1✓ 9.If mainline or deep service repair, describe type of pipe or service line and condition: 10.Manhours: / Crew members: 11.List Materials Used: 12.If you had an accident /incident while performing this request. Did you report it? yes or no 13.Water Utilities mater inspection: pass or fail a 14.How many trips to do task? Signature