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MAINTENANCE INSTRUCTIONS/REQUESTS
Date: S:-3cJ-VY
Time: /2 )'JD f>,-L-,
Instructions: -lip Wit/a ?1265SU.6~
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Name: ;J.tI~H E7Z~
Address: SLflff W6lfl()~u/J ~//L.. ~Z \
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Home phone:
Work phone:
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Customer # \t> z.5Z-&.~ - .'
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maintenance request form
252600
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WOODLAWN CIR SE, 5478
ETZELL HUGH
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4-3849645
,ACCOUNT #
ADDRESS
OLD METER
Ser. No.
Digits
Reading
J!jrlo b
x
July Read 107250
MIU Ser. No.
NEW METER
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Size /
~~2. L{Cj1-
MIU Phone#.
Bldg. Type:
RPZ Installed Yes
No
Service Size
Ground Yes _ NoK
Comments:
Port 1
2
RPZ Ser. No.
''if
Type
lead_ copperAlron Pipe_
Please keep this receipt for your records, The final reading from your old water meter
will be used in determining your next regular bill.
If you have any questions or problems, please contact the Water Department during
normal working hours. Thank you for your cooperation.
INSTAllATION ACCEPTABLE. WATER METER SEAL WIRE IN PLACE.
OCCUPANT'~ SIG\IATURE ~fr~i~~f?, :f;-p~
DATE J 0 J.j tJ 1 PHONE
f I
From 90080 (4-9~) Copy 1 Customer' Copy 2 WS Copy 3 & 4 WD