0000_0825 WATE
:issued T 7iiisha4 �pLoyes �� Grid � m / ap `�.
;lame: ____;.z2, ' " ,, McIntire: D/ ;'-N- {
?hone Number: (32t) : y d -P71 (WIC):
Time for Water locate
Check for: mama? taat...... MAW tw.i Comet law vast= Initial mwr :libation inviable eW
2.3ack=Low Inst. 2. 112ALC 3.faintenance Calm
Back:iow Insp. A.Main Liao A.Pumps A.Lias Locate
&Pelves 3.Water Tower &Inspection
3k.law Cer_.Dare C.Service Line C.Samples C.Tap
D.Sydrants D.3guipmeat D.Lxeavation
Re -Cer:. Date __ 3.3a.sty
. Reason failure: A. Zieet ol. sis B. Now construction C. Poor instaILatior.
D. Other
4. List of safety equipeent at silt. L. applicable:
A. 3arricades 3. ( Cones C. taps D. Lights 3. Other
l/ i
Request
for Se.-vi snare: -' , � ' J(,<.> >, _�'i ��r,�. �r t, ?,5
ai i /
A .1.\ n /
//
: Hetsr /Se_r7ice :.ask: Classify - City: Customer: L •
;. darer Loss (Fsomu4: GPM ?ire plug flushing Total Gallons
3.Was Water Hovered: Yes No
D. Was customer Notified: Vedm ly __. DOOZEIFOCIZA
Vehiele/!!quipmsnt Vied
3. ! f Hetsr C.`tattge Out: Unit # Nil ars !quip )
;.Old Haver ;O9 /G a PO Reading /f 7 u S 7� 0 97�LcL _
3.Nsw Hecery 6 /3 Rsadirtg,,� _ t
41Clja
#22
.. : �r .Old Meter Size/Type: D. New Meter Sisa /Syps
?..Type of work performed or findings:
9.I= mainline or deep service repair, desc :ibo typo of pipe or sewice Line and Condition:
LO . Manhour s : • Crew members:
LL.Lis_ Materials Cud:
L2.If you had ut ac :idene /Lnc.dent while performing this reguesc. OW you repay: Lt? Yes ar no
!J.wacec Umllities serer Lnspecttan: pass or fail