Burch Lot 3-WO 960125WATER UTILITIES DIVISION""
METER INSPECTION
Set Up Account For:.
Billing Address:
Meter Type:
Size:
Vault:
~[eterNumber: ~' 1~2 5 ~0~D ~
~-~pectlo. Co~-=.- ~-~ ~/~
Backflow Devi~;e (If Applicable)
Type:
Vault:
(Cirde One)
Has hddlow Prevention Device been tested on site in its actual setting? Y~s [ No '~
I~ ~o attach test form or fonm. "