RA-1717_10538_CA_ALTWTR_20221128_Evoqua Site Visit POE Request Woods 4714 Gin St

Sheet3
Sheet2
Sheet1
TF#
Poe Site Visit Form
Date of Visit:
Purpose of Visit:
Client:
Yes
No
State System:
Account Number:
Site Name:
Address:
City:
State:
Phone Number:
Alternate Number:
New Tank Numbers:
Size:
How Many:
Approved by:
Quartz Sleeve:
Chlorination Tablets:
Meter Reading:
Other Equipment on Site:
Other Services Performed:
Problems Found:
Comments:
Removed Tank Numbers:
Service Technician:
EMERGENCY NO. 800-204-0324
Install Monthly Emergency Removal Evaluation Other
NC SC WVA VA other
Chlorination Unit:
Iron Filter:
yes no
Cleaned Replaced N/A
yes no
Carbon Changed:
UV Bulb Replaced:
Potassium:
Filters Left on Site:
NCDENR-DWM-UST SECTION
Task (s) to be performed by Evoqua
yes
no
xx
Larry Woods Pty
4714 Gin Street
Raleigh
NC
336-345-1319
Date: 11/28/2022
TBD
Mark Petermann
System leak at one of the effluent valve
near the heater
Do visit in December - Call first
10538.00