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TEST from sta to sta pressure Start Stop Calc. Meas. from sta to sta Injection 24 hr Residual lineal footage Volume (gal) Rate (gpm) Time *Flushing was dechlorinated to less than 0.1 PPM date Water Inspector DATE INSP. WO # CONTRACTOR DISTRICT MAP STREET TEST DURATION LOSS (gal) SAMPLE TAKEN (Y/N) DISINFECTION LOCATION Tester Testing agency Contractor signature CL2 (PPM) FLUSHING* printed name WATER ENGINEERING PUBLIC UTILITIES DATE PIPE SIZE HYDROSTATIC TESTING / DISINFECTION REPORT PROJECT NAME LOCATION HYDROSTATIC TESTING PH: [PHONE REDACTED] FAX: [PHONE REDACTED]