Jack In The Box-WO010117 WATER
Phone ~b~m~). Al tv, x):
Check for: Accuracy test: . Meter Leak:
Initial meter relocation inspections
Check water pressure:
Re-read
1. Bacldlow Imm. 2. Reoair 3. Ma/menance
Bacldlow Insp.. A. Main Line A. Pump
Bldlow Cert. Date B. Valves B. Water Tower
Re-Cert. Date C. Service Line C. Sampl~
D. Hydrants D. Equipment
E. Safety
4. 0thor
A. Line Locate
B. Line Locate
C. Tap
D Excavation
Reason for failure: A. Elect~olysis B. New Construction C Poor Installation D. Other
6. List of safety equipment at site i.f applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
7. If Meter/Set,ice Leak: Classify: - City:.
A. Water Loss (estimate): (3PM __
B. Was Water Metered: Yes
C. Was Customer Notified: Verbally
Fire plug flushing
No
Total Gallons
Doorknocker -
8. If Meter Change Out:
Vehicle/Equipment Used
Unit # Miles l.-L's Equipment
A. Old Meter # Reading
B. New Meter # Reading
C. Old Meter SizvaType:
E. Type of work performed or t-mdings:
D New Meter Size/Type.
9. If mainline or deq:} service r~pa/r, descn'be typ~ ofpip~ or service line and condition:
10. Man-hours:
Crew Members.
11. List Matetiah Used:
12. IfTou had an accideng~ncident while peffom~g ~s request. Did you report it? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How many ~ps to do ts~k?
Signature