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.

Name:

Company:

Phone #1:

Phone #2:

Email: *

Fax:

Mail:

City

Windsor Santa Rosa

State:

Zip:

Payment method ($254 cost of meter):*

Mail (PO Box 100 Windsor CA 95492-0100) Phone (Provide # above for Visa or MasterCard payment)

In person (9291 Old Redwood Hwy Bldg 300A)

Requesting test results via:*

Email Fax

Mail

Hydrants to be tested ($254 cost of meter):

Hydrant #:

Nearest Address:

Hydrant #:

Nearest Address:

Hydrant #:

Nearest Address:

Comment:

Test Results - to be completed by Town staff

Hydrant #1:

Static p.s.i.:

Residual p.s.i.:

Pitot:

Co-efficiency:

Flow:

Hydrant #2:

Static p.s.i.(2):

Residual p.s.i.(2):

Pitot (2):

Co-efficiency (2):

Flow (2):

Hydrant #3:

Static p.s.i.(3):

Residual p.s.i.(3):

Pitot (3):

Co-efficiency (3):

Flow (3):

Complete & forwarded:

By: