Freeport NIP(5.2)-CS 970930~hec~ ~oc: ,~cur~v. uf~.__ .~mT ~ C~k .mr Vnum~: h~d mm~ W ~ b~ud~
1.Back, low Incl.
Backflow Insp.
Bkflow Cea. Dace
Re-Ce.~c. Dace
A.Hain Line
B.V&lvee
C.Service Line
B. Water Tower
C.Smnplee
D. Squiixnenc
&.Ocher
A.Llnm Locate
B.ZnspecCion
¢.Tap
D.ExoavaCion
Reason f~r failure: A. Elecc=olysie B. New conec_-uccion C. Poor installation
D. O'--her
A. Ba=T. icades 3. Cones c. Tape O. Lights E. OCher
?.If Hlcsr/SL,'Vice Look:
A.Wa=er Lose ~m~mml: GPM
:.was Culcc~ne= NonS.died: VerbillF
Fire plug flushing__
No
Dm~UDIOCI~I
~.I~ Me=er Change
A.Old Hecer~ Reading
3.Ney Hecer~ Reading
Tone! O&llone
:.Old HeCer Si=e/Type:
E.Type o~ work per~o=med or findings:
9.If mainline or deep service repair, describe cite of pipe n~ service line and condition:
lO.Hanhoure: " C~lvmem~l:
S Lgnacure~