Deforest Court-WO010822Name: ~ '
Phone Number:
WA-I'ER
Employee: ~ Ch'id map:
(WK): ~'/?U- qo/
Check for: A¢.~a.'acy test:
Initial meter relocation im'pectio~
Me~cr Leak: Check wa. ret pres.sure:
Re-read
Backflow In.~.
Bkflow Cert. Date
Re-Cert. Date
A. Main Line A. ~ A. Li~e Locate
B. V~lves B. Wat~ Tower B. Line Locate
C. Service Line C. Samples C. Tap
D. Hydran~ D. Equ"pment D Excavation
£. Safeb/
5. Reason for failure: A. Electrolysis B. New Constr~clion C Poor Ins~alh6on D. 0~her
6. Lbt of.safer/equipmem ~ sim if a~,plicable:
A. Ban'icades B. Cones C. Tape D. Lights E. 01her
Request for Service~: '?'-~/v,~ &
7. If Meter,'Se.~'ice Leak: Cla.~f.,~: - City:
C~tomer
A. Water Loss (c.s~ima~-): GPM __
B. Wu Water Mct~eg: Yes
C. Wu Customer No~ified: Verbally
Fi~e plug fl~lfi~g Totzl Cmllo~s
No
8. If Meter Ctu~ge Out:
Vehicle/Equipment Used
Unit # .Miles I-'Irs Equipment
A. Old Meter # Reading
B. New Meter # Reading.
C. Old Meter Siz.eFrype:,
E. Type of work performed or findings:
D New Meter Size. Ffype
9. If,~,,i,,llnl or deep service regair, descn'l~ lype of pipe pr service line and condition: _ _ ,..--
10. Man-hours:
1 I. LBt MateriaLs Used:
Crew Membem
12. If you had an accident/Incident while performing this request. Did you repot, it? Yes or no
13. Water Utilities meter inspection: pa~s or fail
14. How aumy a'ip~
Signature
~/10/~001 12:46
972 304 3570
CITY OF COPPELL ENGR, DEPT. ~ 99723043547
N0.065 QO1
TARflANT COUNTY PUBLIC HEALTH LABORATORY
rial TJmJili~y I~. FL WIrtlI, 1X ~1107
WATER BACTERIOLOGY bin. 4mo
'0et* end r, me Fia:'&'~ ! ' ~ ~ -- ~ ~