121 BP Phase 1-CS000817 · WATER
Phone Number: (HM) ~
Check for: Accuracy test:
Initial meter relocation inspections
Check water pressure:
Backflow hasp,
Bkflow Cert. Date
Re-Cert. Date
Meter Leak:
2. Reoair 3. ~ 4. Other
A. Main Line A. Pump A. Line Locate
B. Valves B. Water Tower B. Line Locate
C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
Reason for failure: A. Electxolysis B. New Constxuction C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
7. If Meter/Service Leak: Classify: - City:
Customer
A. Water Loss (estimate): GPM __
B. Was Water Metered: Yes
C. Was Customer Notified: Verbally
Fire plug flushing
No
Total Gallons
Doorlmocker -
8. If Meter Change Out:
Vehicle/Equipment Used
Unit # Miles Irks Equipment
A. Old Meter # Reading
B. New Meter # Reading
C. Old Meter SizeFrype:
E. Type of work performed or findings:
D New Meter Sizefrype.
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Man-hours:
11. List Materials Used:
Crew Members.
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