Devonshire-WO 981222T~me a=az~cod:__ A.M. P.M. Date: TJ3ne fin£lhed A.M. P.M.
1. 2. 3. 4.
A.Use jm Cape
2.Use ~eC truck
C.Use rodding
nmchino
D. Excavation
£. Pressure bag
A. M&ln Line
B.L~ter&l Line
C.outf&11
D. CLean-out
A.LI£C ~&Cion
B.Manhole
C. Siu~ples
D. Equil~nt
A. Line locate
lnspec~£on
Tap
Smoke test£ng
Safe~y
F.T.V
Lis= PCs Used: PL~c #
Employees Equip. Used: Vehicle~
s~oppage on: Cloy Customer %/ In.all clean - out Yea__ or no
S. Have you been back at this em location in the pale 3 months? yea no__
&. Ty~ of problem
A. Cave in C. Hiir rooC E. O~hmr
B. Bad tap D. Bellies or rainbow
7. What needs Co be done Co correct this i£tuation: explain-
8. In =he event of an overflow, did you process a TNRCC repo~: yes or no or n/a
9. EsCJ~aate JeC Truck Gallons Used: 10.EscJ3aaCe gallons overflowed
ll.Was chlorine added to dilenfe~c yes or no
is Sire Bescoracion Needed? yes No 12.Was sight cleaned yes or no
13.Did you make your supervisor
List Safe~y EqullxnenC Installed aC si~ if applicable: aware yes or no
Barricades,__ Tape L£ghCs Other
picture/Video pulled? yes no notify ocher uCil£Cies yes__
Work location: ALley Street XnCersecCion Field
C~scomir conte.c~c: In person Doorknocker/ ~
14.If you had an accLdent/inclden= whale perfo~m£ng ch£s request. Did yoc repoL~c It yes or no