Coppell CC 1B1-WO010621 (2) ~ WATER /'"~
Issued: ~e',,~/' bed: Employee: Grid map:
Phone Numbs:
Check for: Accuracy test: Meter Leak:
Initial meter relocation inspections
Check water pressure:
Re-read
2. Reoair 3.~ 4. Other
Backflow Insp.
Bldlow Cert. Date
Re-Cert. Date
A. Main Line
B. Valves
C. Service Line
D. Hydrants
B. Water Tower
C. Samples
D. Equ~-pment
E. Safeb/
A. Line Locate
B. Line Locate
C. Tap
D Excavalion
5. Reason for failure: A. Electrolysis B. New Conslmction C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Banicades B. Cones C. Tape D. Lights E. Other
7. If Meter/service Leak: Classify: - City:
Customer
A. Water Loss (estimate): GPM __
B. Was Water Metered: Yes
C. Was Customer Notified: Verbally
Fir~ plug flushing Total G-allous
No
Doorknocker -
8. If Meter Change Out:
VehiclefEquipment Used
Unit # Miles Hrs Equipment
A. Old Meter # Reading
B. New Meter # Rending
C. Old Meter Size/Type:
£. Type of work performed or findings:
D New Meter Size/Type
9. If mainline or deep service repair, descn'be type of pipe or service line a~d condition/
10. Man-hours:
11. List Materials Used:
Crew Members.
12. If you had an accident/Incident while performing this request. Did you report it? Yes or no
13. Water U~ilities meter inspection: pass or fail
14. How many trips to do task?
Si nature