1998_1102 C/ WATER
Issued ,� :o� l O, Finished Employee
.2 Grid map
Name: //0 Address: 75 • 9, - te r
?hone Number: (HM): (WX)
Time for Water locate
Check for: Accuracy teat : Meter Leak: Cbeck water pressure: Initial meter relocation inspection Its-read
1.Backflow /nap. 2. Repair 3.Haintenance 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
o. List of safety equipment at site if applicable:
A. Barricades 3. Cones C. Tape D. Lights E. Other
Request for Serviceman: -..,-,L-_,_.. IL 4 C1.-.C. c" • �• -dlit
e.Lt ( )
Meter /Service Leak: Classify - City: Customer:
A.Water Loss (Fstimateb: GPM Fire plug flushing Total Gallons
S.Was Water Metered: Yes No
...Was Customer Notified: Verbally DOORIU1OCXER
Vehicle /Equipment Used
3.If Meter Change Out: Unit # Hiles Mrs Equip
=,.Old Meter# 5Z 7Z/T Yr Reading 6' W 72 /a z7 z3y ,
S.New Meter# 23/51) 5YY Reading ZU'6'
/l 3� i�
C. Old Meter Size /Type: � � ,.) . - -D. New Meter Size /Type l D /7 /�W //Y
I.Type of work performed or findings: 4 -- /� ��
L S ecc(-ire..4cy t 141/L-7_1_7-& - s 4lf s (,Jr i '
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: , %Z- Crew members: 1
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 meter inspection: pass or fail ' xYY
14.How many trips to do task?
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Signature /