Freeport NIP(7.5)-CS011001Check for:.
Check ~ pressu~:
Re-read
Backflow Insp.
BkJIow Cern Date
Re-~'c Dete
5. P.~soa for f~i.lu~:
2. 3. lellin. u
A. Main Line A. Pump A. Line Lc.~__~e
B. Valves B. Warn' Tow.'r B. Line Locam
C. Service Line C S~nples C. Tep
D. HI~'~au D. Equ~-pm~m D Excavation
E. S~e'~,
A. ~lec=olysis B. New Comtmc~a C Poor Inmlimiou D. Od~r
A.h~ricad~ B. Cooes C. Tape D. Li~hts P..O~r
lteques~ for Sclc= .~'~k "i'- ~
7. If Me.... 5¢:','~¢. Le~ Cm-X. - City:
X. Wi~' Loss (es/m~): OPM
B. Wu W~ M~g: ¥~s
C. wu Oumm= .~ Vat~l~
Fire plug flu.d~n$ Tonl ~
No
v ehicletF. Used
Unit # .~es ILs F.q~pm~at
A. Old Meter $ ~d~"g
B. Not Meter ~ l~ad~,g
C Old M¢~r Size/l'?~
E Type of'work peffoP'..,,-'d or ~liais:
D New Meter Siz~T~pe
9. ff ~e or deep mMet ~t-,,l~. describe ~ of pipe or service line taxi condidom .
I I. List Macc~4~ Used:
12. If),au ~a. l.. a¢..de~ ....... r ',,','hilt performing this requcs:. Did you repot: :c? 'Yes or flo
14. How a~ny ~s ~o ~ ~?