Coppell CC 1B1-WO010612PhoneNumbec.(l~l) ~ (WK): ~/7- 3/ ~/~- ..~/9'-.~
Check for: Accuracy test: Meter Leak:
Initial meter relocation inspections
Check water pressure:
Re-read
2. Rena~ 3. Maintenance
Backflow Insp.
Bkflow Cert. Date
Re-Cert. Date
A. Main Line A. Pump A. Line Locate
B. Valves B. Water Tower B. Line Locate
C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavat/on
E. Safe~y
5. Reason for failure: A. Electrolysis B. New ConsUuction 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: l)~ ~J~ ~ ~ ._~ (~_ ~: ~C)
7. If Meter/Service Leak: Claasify: - City:
A. Water Loss (ese/mate): GPM __
B. Was Water Metered: Yes
C. Was Custemer Notified: Verbally
8. If Meter Change Out:
A. Old Meter # Reading
B. New Meter # Reading
C. Old Meter Size/Type:,
E. Type of work performed or findings:
Fire plug flushing Total Gallons
No
Doorknocker -
Vehicle/Equipment Used
Unit # Miles Hfs Equipment
D New Meter Size/Type.
9. If malnllne or deep service repair, describe type of pipe or sex. ce line and condition:
10. Man-hours: Crew Members.
11. List Materials Used:
12. If you had an accident/Incident while performing this request. Did you report it? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How many trips to do task?
Signature
~SI~ED SECON0 NA~R~ ~R~LEO ~ FORM 74620