2000_0622 •
WATER 1 /
d.
U Issued: (6' teed uli 2:1,2__ Employee: ,�j I- I Grid map:
Name: , / // * - Address: V ,) L .( I � "Cele_ /
Phone Number: (FL TO (WK): — A _ - 9 /
Check for Accuracy :es:: Meter Leak: Check water pressure:
Initial meter relocation inspeedoas Re -read
1. $acktlow Insp. 2. Repair 3. ;Maintenance 4 .4I
Back:low Lisp. A. Main Line A. Pump A. Line Locate
Bk:'ow Cer Dace B. Valves B. Water Tower B. Line Locate
Re -Cer Dace C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
S. Reason for failure: A. Electrolysis B. New Construction C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E Other
Request for Services: , S 'f
7. If Meter, Service Leak: Classify: - City: Customer
.A. W ater Loss (el GPM Fire plug • g Total Gallons
B. Wu Water Metered: Yes No
C. Was Customer Notified: Verbally Doorknocker -
Vehicle/Equipment Used
3. If Mt::: C Waage C. :: tit Miles Hrs Equipment
A. Old Meer = 2_2_02,3 2 Reading /.3 Z /
3. Nevi Meter - 2 !) / 3 1 ' $ Reading S
C. C. O1d Meter Size-Type: k ct j^-1,1, e\ D New Meter Sizelype . 2...'"' / , - ?
E. Type of work performed or findings:
9. If ma:.:Ei: a or deep ;err ce repair, describe type of pipe or service line and condition:
1') ..'..1:-.-7.7._:3. /1,c C:e M_...::ers. U'./✓
t 1 . (. :s: ` ::'3 :s Use:::
/16, 0/ /1-, b t -t — L NGr✓ G ?l.( v.., f ei d/tm.- £,3 G 7:s
11. 1:: ...'.lam an lc= . : :dcnc '.here re ::c - this :_:�tiest. Dtd ;ickl :_,cr: .c? V_s Jr no
13. Water Utilities rr:e:er rspection:" or fail
14. How away trips to .o ask' .)",
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