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. CHART� S ` Q 5 <br /> WATER MAIN FAILURE REPORT <br /> DATE OF aREAK - - ' •/- L�' � TIME: • � ; i AM <br /> ?M <br /> RE?ORTED 9Y: Y .� f %� �i� .7 ':... .-� _ 1 ^ . <br /> ^ PHONE ..�—:''�-� �,;� ;=' <br /> ADDRESS: _ /,. ! % �v,f,W��, <br /> IOCAT10N OF BREqK: !.• �� ��,�=� <br /> ..-..:<,.-" <br /> TYPE OF MAIN: _ :.� T SI2E: � JOINT: ....��� <br /> AAAIN I.D. N: -1, . �: i- �C�_S' ;-, ' W.O.N: ••� � ' ' ; z, . <br /> A . r�r.�J� � `� .i�... <br /> DEPTH OF COVER: _ 7 r �1� TYpE OF SOIL: _�� <br /> NATURE OF BRFAK Circumf�rential: �_ Lonpitudinal; <br /> Blowout Joint Split at cora, St��vr. <br /> Misc�llsn�ous --�— <br /> APPARENT CAUSE OF BREAK: Surpe D�f�ctiv� Pip� <br /> Comosion D�t�riontion Improp�r B�ddinp <br /> Hiph Op�ratlnp Pnasur� Dittanntlal S�ttl�m�nt __}G_ <br /> T�mp. Chanp� Contractor M(sc: � <br /> DESCRIPTION: <br /> CONDITIONS FOUND: Rocks Vcids CORROSION: Out �� <br /> ELECTROLYSIS INDICATED (Y/N) OFERATING PRESSURE: <br /> _... _ psi <br /> RE?AIRS VIADE (Materfals): �)i,�;,�; �j �� A � ] • � <br /> , _ (�.r. r ^�j /4.�� t�liC.t c �.. <br /> � �' � .�� .:: C.:1.t .� w l . � .(� � :�.% '� � , . <br /> � � �c—�.� 't-f v�� -i.:. � • ...�. � . <br /> � :' � r��....i' t lr <br /> L <br /> RE?AIR DIFrICULTIES (if any): �.,, �, `� , -� �X <br /> . <br /> � � <br /> DANIAGE TO PUBLIC/PRIVAT'e PROP�t�iY; ��,_�� �� • <br /> Re�air Made by� ��G(_ /:/ � ( C= : /J, <br /> Signature <br /> rouu a'x�n�tr�:s_r� <br />