2001_0205 •
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WA - .
irs"4*Faiiiket 2 - / 2 . t? 6 2 1 7 1 1 3 " e _411" _ . Grid maga _._ •
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Check :cr..a.':s v • Meter Lea
Iaid ai new ciioacca aaeesdoess Check ezoa pcesss:r
Rteead
1. $aefc ?o+• (per 2 Eillilie 3. Mlinsnisim 4. Qfte
Bacdow (asp. A. Main Line A. Pump ' A. Lies Loess
Bt:'.aw Cer_ Due B. Valves B. Wear Ta w B. Lice Locate
Re-Cert. Due C. Service Line C. Samples C. Tsp .
D. Rydrsaes D. Equigtaeac D Excavation
E. Safety
S Luca for eularc A. Electrolysis a Nos Cas sescdo4C Poor fa :a Other
6. tilt o(assi **ow amiss if apptiesbia: .
4. 3arrieadis B. Cones C. Tape D. Lights E. Other .
R.. -• or Savics /! .. _t .. , vi
! . �1 ' ,_ A _ % _ a • , ,r
i . • _ . ,- I_1iifi %�!%/, ! 7l/ifii 'AILhl_� /l1S_►4sit�' , / Y-
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// 1'!'I1 on o/ /i' J�iii ...
7. It `{ Serra Life C assity: - City: Casaotner
A. Water Las: (z sre): GPM Fag plug dashing Tool Callon:
i Was Wva\israst Yes No
C. Wu Casooe:e Ac¢fied: Verbally Doasimock= -
V:ttiekiEquipmeat Used
3. C" .'..::::..71.1.:3: ^_ t. dr *Nees Ka Ec:iptcect
C _' ,( ::_. 7. "g' S ?sands /'/573
3. Y e"r Me= = / Railing
C. Old Mr-n a2s - 44O, a • Sirs Type .
.;fie: D `+e� Meter S'a,.':lpe � /.1' /3 0l /->
E. Type of welt pea •• • or fiakiap:
9. Cf _s _:_e ::'.e:; ;err :: N air, describe .:ype or pipe err serrc: time rad sccdidea:
;') ......._. C':.4/ M: -.e :s.
l : r...;: '•.: ::-i :s :
I 1. , ..... L: L::...... _ :.d: Z: •J.' ::.-: ;e: ;r:tiss3 this ::: O:d !''':. Cr : .0 Y:s .. :c
l 3. W 3: :: L .lice: TX.:: •: s;ectt pu.z Or fit
14 . FT. .7.1.17 rem a ti iic'