SC-Coppell MSW-WO020306 . ' WATER
dMap' .
Check For: Acc~cy Test M~t~ Le~
1. Backflow Inst.
Backflow Insp.
Bkflow Cert. Date
Re-Cert. Date
Initial Meter Relocation Inspections Re-Read
2. Revair 3. Maintenance 4. Other
A. Main Line A. Pump A. Line Locate
B. Valves B. Water Tower B. Line Locate
C. Service Line C. Samples C. Tap
D. Hydrants D. Equipment D. Excavation
E. Safety
5. Reason for Failure: A. Electrolysis B. New Cons~'uction C. Poor Installation D. Other
6, List of Safety Equipment at Site (if applicable):
A. Barricades B. Cones C. Tape D. Lights E. Other
7. If Meter / Service Leak, Classify: City
A. Water Loss (estimate): GPM ~
B. Was Water Metered:
C. Was Customer Notified:
8. If Meter Change Out:
A. Old Meter #
B. New Meter #
C. Old Meter Size / Type
E. Type o f work performed or findings:
Fire Plug Hushing
YES NO
VERBALLY
Total Gallons
DOORKNOCK~R
Reading
Reading
New Meter Size / ;Fype
9. If mainline or deep serv/ce repair, describe type of pipe or service line and condition:
10. Man hours:
I I. List materials used:
Crew members:
12. If you had an accident/incident while performing this request, did you report it?
13. Water Utilities meter inspection: PASS or FAIL
14. How many trips to do task?
YES
Signature
or NO