2000_0810 •
f e ft,4cc'O i1 - 7 - 4
. _.:- .
. WATER
issued i / ri•:aista* 2/1);t2 E mp l oy= / Geed map: .
1 - /
time: � � - . � • / Andress (2 -
Phone `umber (FLM) t4=" '7AL (WIC):
Check nor. Accuracy =c Meter Lealc Check water pressure: •
Initial meter reloadoa inset tons Re -read
L. aacktlow Ins,. 2. Repait 3. Main►n- 4,
Belding, Easp. A. Main Line A. Pump . A. Line Locate
Bow Ce- Date B. valves B. Water Tower B. Line Locate
Re -Ce .. Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation •
E. Safety
S. Reason for btlnte: A Electrolysis B. New Coesunedon C Poor fasullaefoa D. Other
6. List of safety equipment asks if appfieablu
A. Barricades B. Cones C. Tape D. - Lights E. Other n Q
R. sr f r 14 d ,,,,, o,. 1 °�- .
_7:9_,. aze..“....t...4.4... —
7. If MemeSetvice Leak Classify: - City: Customer
A. Water Loss (ale): GPM Fire plug • g Total Ganoas
B. Wu Water Metate& Yes No
C. Wu Castors Notified: verbally Doodmodter -
Vehic ?etEquipment Used
3. r `•:: : :- C:ange C Unit T Miles Hrs Equipment
,3
A. Old M_ :_. = Reading 24 Z/2
3. New Mete: _ 6 G a to , Reading - 2f
C. Old Meter air T1pc: D New Meter Siz= :yre , .t k /
E. Type of antic performed or findings: (/ IP •(e •`s L ,e-et D.o - 72.7e •2 .c..
i IQt., ci ew /W10 1 ..5 A9e,s/ 1.vdx
9. If ::-.i':lae or -e_., se•. repair, describe type of pipe or service line and condition:
M . •'.:- ...: t ) C:: ' M: -ce :s. G' P
1 1. Ls: .r1 ::-1:S F W.!:
12. l:. ._ .'.A: I1 1::...... _ ._:c.:_:Zc ..h:Ie re:fcc^.ung this :tstiesc. Dld you. . :cam .c7 Y:s :::C
13. WV:: (;tilities:rce: es ection: or fail
14. How mazy trips A :a .ask'