CF-Fire Station 1-WO 960719 WATER UTILITIES DIVISION
METER INSPECTION
Employee Making Inspection:
Name of Development :__ ~ .~-', r-e.
Contractor:
Date:
Set Up Account For:
Billing Address:
Meter Type:
Model:
Size:
, Vault:
Back~ (If Applicable)
Type:
Mode::
S~e:
(Circle One)
Has Bacldlow Prevention Device been tested on site in its actual setting? Yes ~0
ff so attach test form or forms. '
WATER UTILITrF-g DIVISION.
METER INS~ON
"Date:
Set Up Account For:
Billing Address:
Meter Type:.
Model:
Size:
Vault:
Location:
Inspection Comments:
Backflow Device (If Applicable)
Type: '~' ~ C
Vault:
Inspection Comments:
Box: ~.~ ~.e--~~
Serial Number: ~/~
(Ch'cie One)
Has Backilow Prevention Devb:e been tested on site In its actual setting? Yes No
Il' so attach test form or forms.
Disk 4 Forms (inspect)