Summit PW-WO 971112 ~ (wK) :_ ~ '
Phone H r: /J '
CheCk ~o~ ~ ~'~
3.~ A.Llnm ~ca~e
Bac~l~ Ingp. A.~in Line B.Ino~ion
B.Wa~
B.VaI~g C.Tap
Bkfl~ Ce~.Da=e C.Se~ioe Line C.s~lo8
D .Hy~~=s D. E~i~n~ D .Excava=ion
Re-Ce~. DaCe
5. Reason ~gr failure: A. Elec=rolysis B. N~ cons=~c=ion
5. Lis= of safe=y e~i~n= a= sics if applic~le:
A. Barricades B. Cones C. Ta~ D. Ligh=s E. ocher
Re~os= for se~ic~an:~
C. Poor ins=ella=ion
D. OCher
~~m Leak: Classify - ce.try:
A.Water Loss ~j~n~u~: GPM Fire plug flushing -
No
3.Was Water Me=ermd: Yes
:.Was Cus=omer Notified: Verbally DOOR]~qO~
~.If Me=er Change Ou=:
A.Old Me=mr#
B.New Me=err
Uni= #
Total Gallons ._
Vehicle/E~uipment used
Miles Hfs
B~uip
Reading ~= I
. Reading
D. New Me't:mr Size/TyPe
".o~.a Meter Si=e/Re: ......t/' / ~ ~ ~
9.If mainline or deep service repair, describe tyl~e of pipe or seryice line lad condi.t:ion~
XO.Manh~urm= .