Laserfiche WebLink
WATER MAIN FAILURE REPORT <br /> n �/ <br /> DATE OF BFEAI!��L,y�� TIME:____ A.M. __�_�.M. <br /> �f_ ,�J ' ' <br /> REFORTED PY: !viS��r.�1'j�/P,���-•_-- FHONE N-------------- <br /> 6 6 ✓ �/ l / <br /> ADDRESSs -----�- ----�G,�4���_v!/� Y------------ <br /> LOCATION OF BFEAK: -���j-------------------------------- <br /> MAIN I. D. M:________,. , W. O. M:_____ PROC�RAM:______ UTIL. ACC:_____ <br /> ,� <br /> TYFE OF MAIN: ______________ SIZE: ____�_ JOINTt ________ <br /> DEPTH OF COVER: ________ TYFE OF SOIL: __________________________ <br /> NATUFE OF. PREAK: Circumferential __ Lonyitudinal___ <br /> Hlowout___ Joint___ 5plit at corp. _�� Sleeve___ � <br /> Miscellaneous--------------------------------------------------- <br /> APPARENT CAUSE OF RREAl:: Surqe___ Defective Fipe___ <br /> Corrosion___ Deterioration___ Improper Heddinq___ <br /> f Hiqh Operating Fressure_ _ Diff erential Settlelment___ <br /> � Temp. Chanqe___ Contractor� Misc.__________________ <br /> DESCRIFTION: <br /> ---------------------------------------------------- <br /> ----------------------------------------------------------�----- <br /> CONDITION� FOUND: Rocl:s___ Voids___ COFFOSION: Out___ In___ <br /> • 'cLECTROLYSIS INDICATED (Y/N> : OPERATING PFESSUFE: _ ____ si <br /> Il --- � �p <br /> ... <br /> �F FAIRS MADE lMaterials) : � �j� X__lf�f_/_____________________ <br /> � _F_��_z,�_1.14__��������i,�s��------------------ <br /> ------------------------------------------------------------------ � <br /> REFASF DIFFICULTIES cIf rny> : _____________________________________ <br /> DAMAGE TO FU�+LIC/PF.IVA?E PROFERTY _r_/_G_�i!/'�_�f�U�^�________ <br /> ------------------------------------------------------------------ <br /> -----------------------------------^------------------------------ <br />