Affidavit of Meter Calibration Test

Fort Bend Subsidence District
P.O. Box 427
Richmond, TX 77469-0427
Phone: (281) 342-3273 Fax: (281) 232-3355

Permittee Name:  
Well No.   
Description of site at location:  
Meter Manufacturer:  
Serial No.:  
Type:  
Testing Firm:  
Mailing Address:    
City    State:    Zip:     
Phone Number:          Ext.:    
Test Supervisor:  
Title:  

Details of Test:  
Date of Test:     
Description of Test:  
Unit Serial No.:  
Please fax or mail a diagram of installation tested, including the test equipment used.  A schematic diagram is acceptable if pipe dimensions are given.  Include a copy of test tape if transit time method is used.
Test Results:
Meter reading at start of test:    
Meter reading at end of test:    
Metered quantity (item 2 - item 1):    
Known standard quantity in test:    
Percent accuracy (item 3 รท item 4 x 100)   
Flow Rate:   
Recalibration:  
Percent Accuracy after Recalibration:  

Remarks:

Applicant/Agent Name:   
Please enter your e-mail address:    
Please re-enter your e-mail address: