Northlake 635(4)-WO001208 WATER
Phon~'Number.ld~) (WK):
Check for: Accuracy test:
Initial meter relocation inspections
t. [lack. flow Irtsu~
Meter Leak: Check water pressure:
Re-read
2. Repak
4. Other
Backflow Insp. A. Main Line A. Pump A. Line Locate
Bkflow Cert. Date B. Valves B. Water Tower B. Line Locate
Re-Cert. Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure:
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
A. Eleclxolysis B. New Construction C Poor Installation D. Othe[
7. If Meter/Service Leak: Classify: - City:
A. Water Loss (estimate): GPM
B. Was Water Metered: Yes
C. Was Customer Notified: Verbally
8. If Meter Change Out:
A. Old Meter it
B. New Meter #
C. Old Meter Size/Type:
Customer
Fire plug flushing Total Gallons
No
Doorlmocker -
Vehicle/Equipment Used
Unit it Miles I-ks Equipment
· Reading
Reading
,. D New Meter Size/Type
E. Type of work performed or findings:
If mainline or deep service repair, describe type of pipe or sea,ce ,line an~d conditionL
I0. Man-hours: Crew Members.
11. List Materials Used:
12. If you had aa accident/Incident while performing this req. uest. Did you report it? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How many trips to do task?
Signature _
Backflow Iusp.
Bkflow Cert. Date
Re-Cert. Date
Issued: l ~ [/~ ~0(~ Fi~ished:
Check for: Accuracy teat: Met~ Le~:
~i~l m~ter rdocafion ~cdo~
2.
A. M~
B. Valv~
C. Se~ice L~e
D.
WATER
Employs: ~f' C~OiJO Gridmap:
Ch~k water pres~e:
Re-read
3. ~ 4. Other
A. Pump A. Linc Locate
B. Water Tower B. Line Locate
C. Samples C. Tap
D. Equipment D Excavation
E. Safety
$. Reason for faih~e: A. El¢c~olysis B. New CousU'uction C Poor Ius~allallon D. Other
6. List of sstety equipme-t at site if applicable:
B ' ades B. Con C. Tape D. Lights E. Other
Request for Services: T t t ~_1 _ ~' ~ ' ~ ~
,~ ' .
'7. If bieter/Service Leak: Classify: - City:
A. Water Loss (estimate): GPM
B. Was Water Metered: Yes
C. Was Customer Notified: Verbally
Customer
8. If Meter Change Out:
A. Old Meter #.
B. New Meter #
C. Old Meter Siz~rype:
Fire plug flushing
Total Gallons
No
Doorknocker -
Vehicle/Equipment Used
Unit # Miles His Equipment
Reading
Reading
D New Meter SizeTType
E. Type of work performed or £mdings:
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Ma~-houn:
11. List Materials Used:
Crew Members.
12. If you had an acciden~]ncident while performing this request. Did you report it? Yes or no
13. Water Utilities meter inspection: pass or fail
14. How ma~y ~ps m do task?
Signature __
1907 FM 1885 * Weaihe~ord, Texas76088 * 817-596-0398 · FAX 596-0399
TRANSMITTAL
LETTER
TO: CITY OF COPPELL
255 PARKWAY BLVD.
COPPELL, TX 75019
A~: Larry Davis
ITEMS MARKED TRANSMITTED:
[] CERTIFICATE OF INSURANCE
[] INVOICE
[] SPECIFICATIONS
[] SUBMITTALS
DATE: 11-14-00
Job NO.: ~' "~-:"~"--'---~
~~C~P;ell Tech ten'er 2
[] CHANGE ORDER
[] PAY-REQUEST SUBMITTED
[] SUB-CONTRACT
[] TAX EXEMPT CERTIFICATE
[] CONTRACT
[] PROPOSAL
[] WATER BACTERIOLOGY
ACTION REQUESTED:
[] FOR APPROVAL
[] APPROVED
[] APPROVED AS NOTED
[] REVISE AND RETURN
[] FOR YOUR FILE
[] FOR DISTRIBUTION
[] FOR HANDLING
[] FOR SIGNATURE & RETURN
[] QUOTE PRICE OR BID
[]
REMARKS OR SPECIAL INSTRUCTIONS:
CC:
MADDOX CONSTRUCTION, INC,
By ROYCE SANDLIN
· ~: ' . TARRANT COUNTY PUBLIC HEALTH LABOBATORY
1806 University Dr.,
t817~871-7245
'WATER BACTERIOLOGY
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TARRANT COUNTY PUBLIC HEALTH LABORATORY
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WATER BACTERIOLOGY tab N0.48010
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UNSUflABLE FOR ANALYSIS-PLEASE RESUBM
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'" TARRANT COUNTY PUBLIC HEALTH LABORATORY ,
1800 Univmsity Of., Ft. Worth, TX 76107
BACTERIOLOGY bbNo. 48010 1817~871-7245
M~th WATER SOUR
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