Wynnpage Plaza-WO020805Phone Number
Check For: Accuracy Test
WATER ~ ..... .~
Employee: //~-~. _ ~-~ C_n'id,Ma~p:
Meter Leak
Initial Meter Relocation Inspections
Check Water Pressure
Backflow Imp.
Bkflow Cert. Date
Re-Cert. Date
Re-Read
2. Reoair 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. Electxolysis B. New Cons~xuction C. Poor Installation D. Other
6, List of Safety Equipment at Site (if applicable):
A. Barricades B, Cones C. Tape D. Lights E. Other
Q STFORSER' CES:
/ /
7. If Meter / Set, ce Leak, ClassiC':
City
A.. Water Loss (estimate): GPM
B. Was Water Metered:
C. Was Customer Notified:
If Meter Change Out:
A. Old Meter #
B. New Meter #
C, Old Meter S~ze / Type
E. Type of work performed or f'mdings:
Fire Plug Flushing
YES NO
VERBALLY
Customer
Total Gallons
DOORKNOCKER
Reading
Reading
New Meter Size / Type
9. If mainline or deep ser~'ice repak, describe type of pipe or service line afl'condition:
10. Man hours:
11. List materials used:
Crew members:
[2. [£you had an acc~denrAncident '~,'hile performing this request, did you report it?
13. Water Utilities,meter inspection: PASS or FAIL
14. How many trips to do task?
YES
Signature
~e NO