IAAM-WO000330 WATER ~)
Employee: ~ Grk[ map:
(WK):
Check for: Accuracy :~: Meter Leak:
[nir~ mete; reloc:~ou
Re-read
~, ~ 2. Reoa(r 3. Maintenance
Backflow L'Lsp. A. Main Line A. Pump A. Line Locate
Bkc'~ow C~?- Da~e B. V~ves B. Wat~ Tower B. L~e L~ate
R=-C~r_ Da~e C. Se~ce L~e C. S~ples C. T~p
D. Hy~ D. E~pmeat D Excav~ou
E. Safe~
5. Reason for f~l~re: A. El~c~oly~L~ B. N~w Consa'ucfion C Poor Iz~l~ll,~on D. Other
7. If Me:er,'Service L.alc Classify: - City:
A. W:~ter Lo~ (~..~.te): GPM __
B. W~ Waccr.~[: Y~
C. W~ Cu~too;~Notifled: Verbally
FLre plug flushing
No
Total GaEo~s
Doorlmocker -
Vehic!e~Equipmem Used
U~it ~ Miles His Equipment
A. Old Me:er = ReadLug
B. New Mete: ~ Rearing
C. Old Met~ S~.e-T?'pe:
E. T,vl:~ ot'wofi: per.'ormed or £mdi~gs:
D New Meter Size'Ty~e
9. If ~"~ke or de~ ~*r4ce :epaiz', descn'~e ty~e of pipe or service li,~e md condi~oa:
I l. Lis: ),ia:e.~a!s Use~:
12. [~' ?'x. ~.ad sa ~c::?.::::;::dent wh;Ie gcrfm."m~.g t~[s ;eo,~est. Did yot~ ;e.:cr. it? Yes or
1 ~. W~te; L't~li[ics me:e; ;.,m'T~.cction: p~ss or F~il
14. How m~.'ty ~p$ ;o ~.o