Test Report For JP Subdivision * Lot # * Site Address * Site Address Site Address Site Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Permit # Location of Device * Installation Date Manufacturer * Please choose one optionAmesApollo/ConbracoFebcoHerseyNeptuneWattsWilkinsOther Manufacturer Model Number * Serial Number * Device Type * Please choose device typeDCVADCDAPVBRPZRPDASPVBDual Check What Type? Well Well/Irrigation Reclaimed or Surface Water/Irrigation Device Size * Please choose size1/2"3/4"1"1-1/4"1-1/2"2"2-1/2"3"4"6"8"10"12" Line Type * Choose line typeBy-passCombinationDomesticFireIrrigation Line Pressure * Meter Number CV #1 PSID Check Valve #1 Please ChooseLeakedClosed CV #2 PSID Check Valve #2 Please ChooseLeakedClosed Air Inlet Opened At Only check if not opened Did not open RV Opened At Only check if not opened Did not open Test Result Please ChoosePassFail Testing Technician Jorge P. RazoAlfredo MirandaEnil Sarmiento Repairs Required? NoYes Comments File Upload Drop a file here or click to upload Choose File Maximum file size: 3MB If you are human, leave this field blank. Test Report for JP
