Villages CC 1-3-LR 971017WATER
Gr£d map
Backflow In·p.
Bkflow Cea. Dane
Re-Ce.-'-~. Dans
Reason for fa£!ure:
2. Reuair
A.Main Line
3.valves
C.Serv£=e Line
D. Hydras: s
A. Elec:rolysi·
3.Main=seance
A.Pumpe
B.WaCer Tower
C.Sample·
D.EquipmenC
E.Safe=y
New cons=--'uc=ion
Lis= of safety e.aui~men= a= si=s if applicable:
4.0=her
A.Line Loc·Ce
B. Inspection
C. Tap
D. Excavation
C. Poor
D.
A. 3arricades 3. Cones C. Tape . D. Ligh=s E. O=he:
Re=ues= for Se.-vicom~n: ' ~' ~
7.If Me=e=/Se~;ice Leak:
A.Wa=er Los· ~-~-~m: GPM
S.Was Wa=e= Hena=e~: Yes
:.Was Cue=omar No=iliad: Verbally __
Classify - Ci=y:
Fire plug flushing __
No
· .If Me=er Change Our:
A.Old He=er~ Reading
3.New ,e=er~ Reading
Toes! Gallons
Vehicle/Equipment used
Unic# Miles Hfs Equip
C.Old ~e=er Sioe/~e:
E..Type of work performed or findings:
D. New He=ar Size/Type
9.If mainline or deep se:vice repair, describe =ype of pipe or service line and condi=ion:
10.Manhours: Crew members:
L1.Lt·= Ma=·rials Used:
~3.Wa~er U~l~i~.. ~.r ~n.~c~Lon, p... or fail
:4.gow many CrLp. Co do Ca.k?
SLgnacu=