2000_0919 A /c,. 7 6- — 7 - 6-
•
• WATER
Issued: •-/9-o 6 Ectistect 9-/f "60 E Loyea lr
Na=e: Address: 1ZZ 5 T// 14/ €t 7e�-✓
Phone `verse- (fC4)
Check ;or. A-curxy =:. Meter Leak Cbeeit crater pressure:
•
EMU =seer &goeaded ins e s Re-read
L. Baek:Tow [ass. 2. Bank 3. Mahe i. Dshat
Bac,clow Lam. A. Main Line A. Pomp A. Line Locale
Bic:'.ow Ctn. Dace B. Valves B. Water Tower B. Line Locate
Etr - C Dace C. Service Line C. Samples C. Tap
D. Hydraat3 D. Equipment D Excava iaa
E. Safety
S. P easoa for fad= k Electrolysis B. New CamQnetioa C Poor ussoduise D. O
6. List of safety equipment at site if ap_ticabla
A. Barricades H. Cases C Tape D. Lights E. Other •
Request for Services: A Y' U/ DA
7. >t MME Se:vie: Lak Classify: - City: f Customer
A. W VAX Loss (x te): GPM Fire plug g Tool Callous
B. Wu Waterlfeereck Yes
C. R u Costa= gasified: Verbally Dootkoci= -
Vehic!aEquipozeat Geed
3. Ccit T }Cues Ho Equipment
C M : : A. - 'l D 9 i s/ B Reading // Z P
3. `ew M e r e ? 4 2 , , 6 'a go v Reding
M e t e r C. fie: J76 x ,3 /°4., New Meter SizeT e
E. Type of t per formed or g s ua
:
9. if or :fee; ter fair, describe type of pipe or service tine:cd condition:
,.) . `. :....: _ 2- S' Crew t -.e :s. G. d /044/
4/c 6✓ /'S 7r t .L f" e/7/.- G ove
1'_. this :_cues;. O :C .0 Yes ..:c
13. vire: (:names «xer zs eccioa: or fail
14. How .;1t f Tips O