Windance Sub-LR 850925GINN, INC.
CONSULTING ENGINEERS
Project:
Date: ~-Z~'
Diameter:
UTILITY LINE
INSPECTION AND TESTING
Area: ~/! o~zz/~f//~c~ Line:
Length: 5D Plan Sheet No:
START
Time: ~,~
Pressure: 2~
Allowable, Leakage Per Day:
(ll.&~ gpd) X
PRESSURE TEST
FINISH
Time:
Pressure: ~_~
52-/z ~ ~
~o~¢miles of pipe) X (~'~' inch Diameter)
Gallons Lost Per,Day:
( ~) Gal. Lost) + (_.~Hrs. Tested) X 24 Hrs. =
Passed: .~. Rejected:
50.5~'~ 2v-t~,,~
INFILTRAT !ON/EXF I LTRAT~ON TEST
START F I N I SH
Time: Time:
Allowable Leakate Per Da),:
(2SO gpd) X [
miles of pipe). X ( inch Diameter)
Gallons Lost Per Day:
( Gal. Lost) , ( Hrs. Tested) X 24 Hrs. =
Passed: Rejected
COMHENTS:
Tested Performed By~,.. ~4~-~. ~ ) ~_~ -~
~ Rejected B/: ~~,~Z'~'~-- ~ ~
13,10 Midway Road · Su~2 · Dallas. Texas 75234e Phone 21,1/3~11