MacPlaza 1 Sun-WO 961017Phone Number: (HM):
Employee A O~_.~ ~ , Grid map _
(WK):
Time for Water locate
Check for: A¢¢u~¢y ~st:
1.Backflow InsD.
Backflow Insp.
Bkflow Cart. Date__
Re-Cert. Date
2. Repair
A.Main Line
B.Valves
C.Service Line
D.Hydrants
$.Maintenance
A.Pumps
B.Water Tower
C.Samples
D.Equipment
E.Safety
5. Reason for failure: A. Electrolysis B. New construction
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights
Request for Servicemen: %~/~, ~'~[~(~ 0`/~
E. Other
4.Other
A.Line Locate
B.Inspection
C.Tap
D.Excavation
C. Poor installation
D. Other
7.If Meter/Service Leak: classify - City:
A.Water Loss ~stimat~): GPM Fire plug flushing __
B.Was Water Metered: Yes No
C.Was Customer Notified: Verbally __ DOO~KNOCKER --
8.If Meter Change Out:
A.Old Meter~ Reading
B.New Meter# Reading
customer:
Total Gallons
Vehicle/Equipment Used
Unit ~ Miles Mrs Equip
C.Old Meter Size/Type:
E.Type of work performed or findings:
D. New Meter Size/Type
9.If mainline or deep service repair, describe type of pipe or service line and condition:
10.Manhours: I/~ Crew members: ~
Il.List Materials Used:
12.If you had an accident/incident while performing this request. Did you report it? yes or no
13.Water Utilities meter inspection: pass or fail ~
14.How many trips to do task? ~
Signature~ ~ O