Jefferson-CS 961101Time ~or ~acs~
Back, low
~kflow Car=.Da~e
Re-Car---
Reaecn for fa~iurm:
A.Main Line
B.Valves
C.Service Line
D.Hydran=s
A. ~umps
B. W&=er Tower
c.$amples
E. eafe~y
A. Elecnr=iysis
C. Poor ins=ai!a=icn
D. O=ner
- ':e- -= safe=': ec~ipmenn an s~:s .. D:./%ign=e 5. O=her ! .
7.if Me=er,'Se~:~zs Leak: C.ass.-. - - --------
A.Wa=~r Loss ~=,: G~M :i~ :!uc f!=s~ing
No
2.Was Cus==mer Ncn~fied: VerDaily __ ~P~O~'X --
~.2f Mensr chang~ Cu=:
Uni= $
To=al Gallons
';enicle/'Eq~i~men= Used
~iles ~rs
2.Old Me=st SL:m/-~.~Pe:
S.Type of worx perf=--med or findings:
New Me=er Sioe/T'rue )
9.if mainline or deep service repair, describe type of pipe or service line and ¢ondi=ion: