0000_0622 •
WATER
Issued___ Finished: &aplo Grid map: ,Q
Name: e: PG, 2 v Address:
Phone `:ureter (FD O �33 - U// 0 (WK):
Check or Accuracy :esr. Meter Leak: Check water pressure:
Initial .meter relocatioa insrec -zoos Re -read
1. $acktlow Insp. 2. Repair 3. Ntaintenance 4. Other
Back:low Lisp. A. Main Line A. Pump A. Line Locate
Bk ow Cert. Dare B. Valves B. Water Tower B. Line Locate
Re -C:r:. Dare 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
l A. Barricades B. Cones C. Tape D. Light: E. Other
Request to Services: G" / // i!_ _t % i%Zt�lt c. /fie
ms `� / Oz/� Is...��•` J� 2" _ i - - _
7. If Meter; Service Leak: Classify: - City: Customer
A. Water Loss (es GPM Fire plug flushing Total Gallons
B. Was Water Metered: Yes No
C. Was Customer Notified: Verbally Doorkttock:r -
Vehicle/Equipment Used
3. If `:_:_- Caaage Unit 4 Miles Hrs Equipment
A. Old Me:er = ! 5- t a G.s`NY Reading /I '/51
3. New Meter = 1 1 area 'b Reading b
C. Old Meter SizeT; pe: D New Meter Size: tyre /? / 3/v 4"
E. Type of work performed or findings:
9. It or deep service repair, describe type of pipe or service line and condition:
10 6../ L✓ C-
11 L :s: Mrenals Used:
I 2. if 'A. ^.:;e performing this .equesr. Did I ._ :cr :t? Yes or :o
13. Wa :er Lalines meter Erection: pass or fail
14. How .razy trips !o 'o :ask?