121 BP Phase 1-CS000609 WATER
Phone N~,mber: (H~
Check for: Accuracy test: Meter Leak: Check water pressure:
Initial meter relocation inspections Re-read
1. ~ 2. R~air 3. ~ 4. Other
Backflow lusp. A. Main Line A. Pump A. Line Locate
Bkflow Cert. Date B. Valves B. Water Tower B. Linc Locate
Re-Cert. Date C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D Excavation
E. Safety
5. Reason for failure: A. Electrolysis B. New Conslxucfion C Poor Installation D. Other
6. List of safety equipment at site if applicable:
A. Barricades B. Cones C. Tape D. Lights E. Other
Request for Services: lbtC ,
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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 Hfs Equipment
A. Old Meter # Reading
B. New Meter # Reading
C. Old Meter Size/Type:
E. Type of work performed or fmdings:
D New Meter Size/Type
9. If mainline or deep service repair, describe type of pipe or service line and condition:
10. Man-hours:
Crew Members.
11. List Materials Used:
12. If you h~d ~n ~cciden~']ncident while perfo~g this request. D~d you repo~ it? Yes or n0~/~ ~/
13. Water Utilities meter inspection: pass or fail
14. How many trips to do task'?
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~,~ SEE YOU