To certify the testing of the apparatus below in the manner prescribed of which has been witnessed by their client or agent. Complete all the shaded boxes, circle the appropriate yes/no, pass/fail.
Your Email
Site Name
Installation address
Location of Test
Apparatus function, e.g.: Hydrant / gas main
SDR
Size
New
Existing
Water
Gas
Date of install
Start time
Finish time
Duration
Water Test
Air Test
Test Pressure
Test Outcome
Name
Employed by
Signature
A copy of the certificate has:
Been given to the customer yesno
Will be e-mailed to the company yesno
