Burch Lot 4-WO 960326WATER UTILITIES DIVISION
METER INSPECTION
Set Up Account For:
Billing Address:
PHONE #
Meter Type:
M.el:
Size:
Vault:
Meter Number:
ln~pecti0n Comments:
Backflow Device (If Applicable)
Model: ff___~_~, T ,,/~e~d
Size: / 1/
Inspection Comments: ~/-'' A
. __-.. . /.~ 7~'
"-~'~'~'-- ~' ~ .... N
Has Bacldlow Prevention Device been tested on site m its actual setting. Y__Y_~ 0
If so attach test form or forms.
Disk 4 Forms (inspect)