Round Oak-WO 940609WATER ISOLATION REQUEST AND/OR METER RELOCATION
The following information must be provided in order to allow
isolation of any part of the City of Coppell Water System.
This form must be completed and submitted to the Utilities
Division for processing twenty four (24) hours prior to the
date the isolation is requested.
Date:~u~f 9' Time: ,/~ ~0'
Project:
Contractor: CV~]o~ CON MT
Contractors Representative:
Phone # .$~ ~6 q~
Time Off. ~.'' 9 ~ a.m./p.m. (
Time On: '-,0' ~'~' a.m./p.m. ~ ~__.,.~' /
Water Main Size. ~" Inches ~ /
shall provide a list of each of those business or residential
structures affected.
* Note:
The Cit~ of Coppell Utilities Division shall perform
all water line shut-downs. Contractors are not
per~tted to turn an~ valves in the system.
Signed: ~-/~ ~$ ~ ~/~F~ ye 6/~. h f'
/Contractors Representati .,Date
FOR METER RELOCATION OITLY:
Date Amount of Payment
* (Attach work order for relocation only)
Initials