CF-Fire Station 1-WO 960719 (2)WATER UTILITIES DIVISION
METER ~SPECTION
Employee Making Inspection: ~ a cf ~ ~ ~ ~ Date:
Name ofDevelopment: ~-',c~ C-~i~'~'~ _t~_,.~ (~c.G1 /
Address: <a~'~J~ ~'-~ ~ c~'- '~ C~ v ~_o~ [/
Contractor: ~/~: c~ - ~ 0 ~,:~L,~
Set Up Account For:
Billing Address:
METER
Meter Type:
Model:
Size: ~.- ~''''
Vault:
Meter Number:
Location: ~/ ~
Inspection Comments
Backflow Device (If AppHcab~'~
Type:/
S~ze:
tlc,
Vault:
Box:~-~- .~r/~,,~E~ Serial Number:
Inspection
(Circle One)
Has Backflow Prevention Device been tested on site in its actual setting? Yes NO
If so attach test form or forms.