Magnolia Village-WO010924Phone. ~bet~ (}LM) __ -
Check for. A::ur'icy ecsc: __
~ter Le~k:
I. ~ 2. Rmalr
Ch~k wa~er pres~ur.-:
Re-read
3. Mainteeane~ 4. Other
Uackflaw Insp. ^. Main Line ^. ~ A. Line
Bkflow Cer~ Date B. Valves lit, Water Tow.*r n. Line
Re-Cert. Date C. Service Line C Samples C. Tap
D. Hydrants D. Equi'pment D Excavalion
E. Sa. feb/
$. Re,son for f~e: ~. EIcctzolysh B. New Cozut~uct~ou C Poor Izatilla~a D. Cheer.
6. Li~ of s~e~ e~L~pmea~ u site i~' ~licable:.
· r'"~' aan'icades B. C~oaes C. Tape D.
~ .'00
7. H'N[e :r.'$e:'4cr Le~c CI~s:=¢- . City:
A. Wac~ Loss (ea'f. me): GPM,
B. Wu W~tet Mc~'~I: Yes
C. Wu C~,~merNoEied: Verbally
, Fire plug flushia~ .. To,-I C, alloas
Doorkzmcker -
'9'ehicle~quipment Used
Unit # Miles Hfs Equipment
D New Meter Siz~JType.
1 I. LLsc Mite~aL~ Used:
12, 1£ you hag l.'. acciden,'~.;:4..:c '.~,hile performing ~is rcqucs:. Did you rede :c? Yes or no
[ 3. W~cer L'~h~es me~ ~:cn: p~s or fail
14. How ~y ~ ~ 40 ~?