2. Please submit this form to obtain flow test information. Your request will be submitted to Public Works for processing. Please allow 4 working days (Monday - Thursday) to receive the results. Any questions regarding your flow test may be directed to Public Works Water Operations.
4. 
   
6. Name:
7. Company:
9. Phone #1:
10. Phone #2:
12. Email: *
13. Fax:
15. Mail:
16. City
    -- Select One --WindsorSanta Rosa
17. State:
18. Zip:
20. Payment method ($237 per test):*

    1. Mail (PO Box 100 Windsor CA 95492-0100)
    2. Phone (Provide # above for Visa or MasterCard payment)
    3. In person (9291 Old Redwood Hwy Bldg 300A)
22. 
    
24. Requesting test results via:*

    1. Email
    2. Fax
    3. Mail
26. 
    
28. Hydrants to be tested ($267 fee per test):
30. 
    
32. Hydrant #:
33. Nearest Address:
35. 
    
37. Hydrant #:
38. Nearest Address:
40. 
    
42. Hydrant #:
43. Nearest Address:
45. 
    
47. Comment:
49. 
    
51. Test Results - to be completed by Town staff
53. 
    
55. Hydrant #1:
56. Static p.s.i.:
57. Residual p.s.i.:
59. 
    
61. Pitot:
62. Co-efficiency:
63. Flow:
64. 
    
66. 
    
68. 
    
70. Hydrant #2:
71. Static p.s.i.(2):
72. Residual p.s.i.(2):
74. 
    
76. Pitot (2):
77. Co-efficiency (2):
78. Flow (2):
80. 
    
82. 
    
84. 
    
86. 
    
88. Hydrant #3:
89. Static p.s.i.(3):
90. Residual p.s.i.(3):
92. Pitot (3):
93. Co-efficiency (3):
94. Flow (3):
96. 
    
98. Complete & forwarded:
99. By:
Leave This Blank:


101. 1. Receive an email copy of this form.
102. Email address

     This field is not part of the form submission.

103. Submit Submit and Print

* indicates a required field