0000_1027 •
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� Employee: Grid ceid etIF
Addresr 9x3 (),d 3 1 /
Phone Nxeer (FLTr
Chec:c for. A:cucxy ?„(erer Leak Check grater pressure:
faith new : ieloads:a iaresczoas Re-read
[. Baefc tow fats 2, gwait 3..Mpinliria0C. 4.
Hacdow tarp. A. Males Line A. Pump • A. Lis Locate
Beow Ce = Date B. Valves B. Waxer Taws B. Line Locate
Due C. Service Line C. Samples C. Tip
D. Hydrants D. Equipment D Ezavudoa
E. Safety
S Remo for & A. Electroiyis H. Now Camoaictoa C Poor fosalladoa D. Odter
6 . L st of safety *pees at sits if apptiobie:
A. Barricades B. Cones C Tape D. Lights Atha
Request far Servicx , . - % 4j
7. It M Service Late Classify: - City: Customer
A. 'Nita Los: (-nor): GPM Fare plug fleshing Total Woes
B. Was War Yes No
C. Ws: Castosc Sodffed: Verbally Doa:imodrr •
V- _hicreEquipozeat Used
3. :.... �: �; ;e': �- Ceir *Nees EFrs Equiparear
A. - Reading
3. Nev Merl = Reding
C. Old Mfrs Si: -.fie: 0 New Meter Sizetrype
c Inc ends performed or findings: I i r -tea .ti L coal
E,, p et v
9. r: 3 C !Cr,: ;t7r := :27 air, describe type or pipe or rtes t� a rrd coedidoa
re :forming this : '1 :5 :. O. Y :s ::::o
:C
l3. '�►i : :: �at;ces Trr. rreecioa: or fait
( .1.( zips D 1JYt <.