Stratford Manor-CS010604 ~ 972 304 3S,~7
~,~,~( fi:gG Cf?Y F~ COPPELL ~ CITY OF COPP£LL ~o.~? ~
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06/04×01 14:56 CITY OF C0PPELL a CITY OF COPPELL N0.007 ~02
WATER
Check ~or: Acc~cy test: ~eter Le~: ~eck wa~r ptess~e:
~ai ~tcr reloca~on ~ec~o~ Re-re~
1. ~ackflow ~_ 2. ~ 3. Malnmnance 4. O~e~
~ow Cert. Date ~, Valves B. Wat~ Tower B. L~e L~ate
Re-Ce~ D~e C. ~icc L~e C. S~ples C. Tap
D. Ny~ D. E~ment D Excava~on
7. If McteffSc~icc Le~: ~s~: - Ci~: Cmtomer
A. Wa~r Loss (cs~te): GPM Fke plug fl~g Total ~Uo~
B. W~ Water Memted: Yes
C. W~ C~wmcr No~ed: Verbally - Door~ocker-
Ve~cl~quipment Used
8. If Meter ~le Out: U~t ~ Maes ~s Eq~pm~t
A. Old Meter ~ Read~g
B. New Meter 9 Rea~g
C. Old Meter S~e: . D New Met~
E. T~ of work ~omed or ~gs: _
~. If~e or de~ so.cc r~a~, describe ~e of pipe or s~icc ~ ~d con~on:
10. Man-ho~s: _ Crew Member.
! 1, L~t Matlab Used:
12. If ~ou h~d ~n aecid~n~ncid~nt ~hil~ peffo~g ~i~ ~,qu~t. Did you
13. Wa~r Ufilihes meter ~ccfion: p~s or
14. How ~y ~ps m do ~k?