Peninsulas-WO010824Phone N~umber: (I~ g
~eck for: A¢~,rscy test:
Initial meter relocation insp~ctio~
Meter Leak: Check water prepare:
Re-re~d
2. Reuair 2 - ]~!illlgll.ltt.C~ 4. Other
Backflow Insp.
Bkflow Cert. Date
Re-Cea Date
A. Main Line A. Pump A, Line Locate
B. Valves B. Water Tower B. Line Locate
C. Service Line C. Samples C. Tap
D. Hydtams D. Equ:~ment D Excavation
E. Safe~
5. Reason for h~lu~e: A. Electrolysis B. New Co~u'uction C Poor In~taJ~tion D. Other
6. Li~t of s~'ety equipm~t st si~ ii'applicable:
A. Ban'icade~ B. Cones C. Tap~ D. Lights E. Other
7.~f Meter,'Se.~'ice Le~k: Cla.~L~: - City: Customer
A. Water Loss (wt/m~t~): GPM __
B. W~ Water Meter~ Y~
C. Wa~ ¢~mmer Notified: Verbally
Fire plug flushing Total Gallo~
No
Doorlmocker -
8. IfMeterChaggeOut:
Vehicle/Equipment Used
Unit # Miles Hfs Equipment
A. Old Meter # Reading
B. New Meter # Reading
C. Old Meter Siz~tType: D New Meter Sizdl'ype.
E. Typ~ of work l:~formed or ~nding~:
~/I. . ~ Df., ~ ~ ~ - _ . ~
/ IF, > plO T N
9. ff ' ' e or ~ se~ce ~k, ~es~ ~ ol pi~ or s~ce ~e ~d coa~do~ .
10. Ma.~-hou~:
11. Li~t Matefiah Used:
Crew Members.
12. If you had an accidem/Incideat while performing this request. Did you repon it? Yes or no
13. Water Utilities meter inspection: pass
14. How many ttil~ to do la.sk?
or fail