Park West CC(14)-CS 970930 WATER
?hone Nu~e=: (~): (~): . .
Check for: ~cu~ ~__ M~r ~ ~ wa~ ~m~ ~ ~ ~fioa ~__ ~
Backfl~ Insp. A.Main Line A.~e A.L~e Loca:e
B. Val~s B.Wa~or T~er B. Ins~ion
Bk~low Ce~.Da=e C.S~ice Line C.S~leS C.Tap
D. Hy~=s D. E~i~n= D. Excava=ion
Re-Ce~. DaCe E. S~e=y
=. Reason ~o= ~ailure: A. Elec==olysis B. New oceanic=ion C. Poor in~=alla~ion
~ .
~. ~Lis= of safeny ~ipmenc a= S~ce i~ ~pplic~le:
A. Barricades 3. Cones C. Ta~ D. Lighcs E. ~he~ _
7.If Me=er/Se=-~ice Leak: Classify - Ci=y:
A.Wa=er Loss ~-;--m: GPM Fire plug flushing
B.Was Wa=er Metered: Yes No
:.Was Cus=omer Notified: Verbally DOOR]~NOCX~R
~.If Meter Change
A.old ~ecer~ Reading
B.New Mecer~ Reading
To=al Gallons
vehicle/Equilmnen= Used
UniC $ ~iles Hfs
Equip
C.Old Meter
E..Type of work perle=ned or findings:
D. New Meter Size/Type
9.If mainline or deep service repair, describe 'type of pipe or se~ice Line and condiCion:
~O.Manhoure:
you had an accident/incident whALe pe,fo~ming chis re~ueec./oOld you report lC? yes or nc
~3.w&cec O~l~lCio..Ce, £nepecc~on, pass o= fail
~4.How many c=~pe ~o do Cask?
SLgflacu~e ..