Site Evaluation Survey (One Form Per Water Meter)

Client Information

Business

Site Information

Water Source:

Components Downstream from Water Meter

List all equipment and special requirements Eg: (6” Pipe, 6” Gate Valve, 8” Pipe, 8” Backflow Preventer, Pressure Boosters, Cooling Tower, Production Equipment, etc.)

[The above information must be fully completed to assure correct installation.]

Other Details

The following must be submitted with site evaluation:Photos of water meter and all piping connected to and downstream of meter.

Photos of water usage equipment and water piping surrounding the equipment.

Production / occupancy information as it relates to water / sewer usage.

Copy of four most recent water bills, or summary of annualized consumption and costs.


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