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' Field Maintenance Re'"*?rt Form Person Calling: Operator Responding: Date/Time Called: Date/Time Responded: Address: Total Field Time: Phone: Total Travel Time: Service Calls Alarm Call Addendum i Type of System: Conditions Leading to Call Meter Readings(refer to ETM/CT Log&Worksheet) ❑Alarm ❑Tank Overflow Days Since Last Reading: ❑Odor ❑Surface Runoff Today's CT ❑Noise ❑Sewage Backup Today's ETM: ❑Other. Frequency(CT/Days): ❑Normal ❑High Cl Low Odor Duration(MinJCycle): Normal: ❑Musty ❑Earthy ❑Moldy ❑Normal ❑High ❑Low Pungent: ❑Sulfite ❑Cabbage ❑Decay � Typical average daily flow: Date/Time Discovered: / Typical average weekly flow: Method of Detection: l Pump Test Alarm Pump Pump#1:Tank Pump ❑High Liquid Level ❑On Voltage at Rest: ❑Low Liquid Level ❑Off Voltage while Pumping: ❑Off Amps while Pumping: Tank Liquid Level Circuit Breaker Pumping Head(Ft.): ❑Normal ❑On Shutoff Head(Ft.): ❑High El Off Drawdown Time(Min.&Sec.): 17 Low 11 Tripped Drawdown Depth(Inches): Pump#2: Discharge Pump 11 Switched Voltage at Rest: Cause of Malfunction Voltage while Pumping: I Mechanical Physical or Process-Related Amps while Pumping: ❑Control Panel ❑Power Pumping Head(Ft.): ❑Pump ❑Back Pressure Shutoff Head(Ft.): j ❑Float Switch ❑Air Bound Odor ! ❑Screened Vault ❑Sludge&Scum Normal: ❑Musty ❑Earthy ElMoldy ❑Hose&Valve 11 Clog Pungent: ❑Sulfite ❑Cabbage ❑Decay ❑Check Valve ❑Infiltration/inflow ❑Building Sewer ❑Exfiltratlon Method of Detection: ❑Service Line ❑Siphoning Squirt Height: ❑Other: ❑Other: Valve Position at Departure Hose&Valve Assembly: ❑Open ❑Closed Repair. End of Laterals: ❑Open ❑Closed Replace: ControVAlarm Switch at Departure i MOA: ❑Manual ❑Off ❑Auto C8: ❑On ❑Off Repair: Replace: Observation: Action- Comment-