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SAMPLE <br /> <br />Contrac~ No. <br /> <br /> State of California <br />?he Resources Agency <br />Department of Water Resources <br /> Office of Water Conservation <br /> <br />LEg DFTFCFiOM CR~d- LE,~j< REPCRT <br /> <br />Agency Leak ~o. <br /> <br />Meter Leak C ] Main Line Leak <br />Meter S~ud Le~< r ] Service Leak <br />Meter Yoke Leak [ ] Fire Hydrant Leek <br />Curb Stop Leak f ] Valve Leak <br />Joint Leek ~ ~ Other-See Remarks <br /> <br />Location <br /> <br />Date <br /> <br />Type of Cover <br />Concrete <br />Asphalt <br />Soil <br />Other <br /> <br />Action Taken <br /> <br />Leak Pinpointed: Yes r ] <br /> <br />No [ ] Estimated Leakage <br /> <br />Action Reccm~ended <br /> <br />Leak Repaired: Yes r ] No r ~ <br /> <br />Material Cost <br /> <br />Person Hours <br /> <br />Fill in the following for leaks in services ~nd mains: <br /> <br />1. ~treet name <br />2. ~eter number <br />?. North arrow <br /> Draw in main and hydrants <br />5. Show valves and valve number <br />6. L~cate leak to nearest <br /> intersection or house with <br /> address. Show Jimensions .an <br /> prcper~y lines or street <br /> cen~erlines. <br /> <br />R~=,narks: <br /> <br />(GPM) <br /> <br />Signature <br /> <br />SAMPLE <br /> <br /> <br />