2000_0620 WATER
issued: ,- . 6.7 e , c Finished: L-49-co Employee: 6- / r Grid gyp:
Name: : -..SAN o/
Phone `•�:.ce^ ON) Addtess� � L4 of x, ®� /fl �!°�
(am) :. a -iv we, 4 r A -
Check for Acrcurscy :es:. Meter Leak: Check water pressure:
Initial meter relocation inspections Re -read
1. $aektlow Imp. 2. $air 3. Mainceoaeeee 4.03u
Back:low Luc. A. Main Lme A. Pump A. Line Locate
Bow Cer Dace B. Valves B. Water Tower B. Line Locate
Re-C Dace C. Service Line C. Samples C. Tap
D. Hydrants D. Equipcent D Excavation -
E. Safety
3. Reason for failure: A. Electrolysis B. New Consctucdon C Poor Installation D. Other
6. List of safety equipment at site if appfiabir
A. Barricades B. Cones C. Tape D. Lights E Other
Request for Services: f /a q 1 ry 7 e 4 — ,(2/44 G '1„,..-4 C',‘z S d/e O
7. If Metre Service Laic Classify: - City: ( Customer
/
.k. W irer Loss (es te): GPM Fire plug flushing Total Gallons
B. Wu Water Metered Yes No
C. A as Costc Notified: Verbally Dootkorocker -
VehicteEquipment Lied
3. If `•I_ :e- Crange C'. :: Lcit 4 Miles Elrs Equipment
A. C _ `de. - . = 05 l 74 Reading
3. New Me:e: =,1_7 J 3. O 7 Reading _
C. Old M e t te r S z fl :ype: s ' ' 2 tc D New Meter Size Type / 1Z/) 2 `°
E. Type of wodc performed or findings: ter, .00 ; , ON D :O /1., ` 7e, N/.33
C R(... t ileA
9. If ma'..:::::-..e ar deep service repair, describe type of pipe or service line and condition:
11. L :s: •la: ::-a :s Lse..:
/ t.✓ ", 7
1?. is _ ' ::... 1:.: : :7: .:. 1c ..k ::e re : :c ••••• 3 this :: t esc. Dtd :iv; . :c .c? Yes Y. :o
13. Ws::: Lrclicies meter es ection: • or fail
14. How .:i.:.! nips to .o asi' 7-
S : ;zatsr-
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