2002_0328 WATER
Issued: 3-Z'D0 Finished: fir. 7 Employee: YlbrilL Grid Map:
Name: • 13itlic. Address: (Dl Trail w a-
Phone Number (HIM): (WK):
Check For: Accuracy Test Meter Leak Check Water Pressure
Initial Meter Relocation Inspections Re -Read
1. Backflow Inge. 2. Mak 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: rft'ker k a ( k ' ) -; -tr - .0 k .e • 1
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 ;# /S 3 Reading / / ^ /
B. New Meter # X #1 , 3 Reading
C. Old Meter Size / Type New Meter Size / Type
E. Type of work performed or findings: C .e) Ott- nde / LL er i .k 1rf
e ork siep .
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Man hours: Crew members:
11. List materials used:
Post -it® Fax Note 7671 Date 4 -6 -02 Ipa °ges■ (Z
12. If you had an accidentiincident while performing this requ To 411aii Johns From Debi, imatert
13. Water Utilities meter inspection: PASS or FA Co. /Dept. • t' Co. et 'i',•�"L7' eg
Phone # � �`'�` y J Phone # I ` 'w
14. How many trips to do task?
Fax # Fax #