Hydrostatic Testing Request Form Site Name* Site Address* Street Address Address Line 2 City State ZIP Code Site Phone Site Contact Name First Last Contact Phone Contact Email Photos of equipment to be tested Please email site photos to: Justin@rmdalrymple.com Comments, Questions, Concerns Pricing Dispenser Sumps – $235.00 each Tank Sumps – $235.00 each Spill Buckets – $60.00 each Overfill Valve- $95.00 each Please note the above prices do not include tax. Clauses: ***Customer is required to clean equipment (sumps and containment) prior to Dalrymple arriving to test.***Any required cleaning by Dalrymple to perform the Hydrostatic testing will be billed as an extra at $112.50 per hour.***No Remediation work will be performed at the time of the test. ***Test result paperwork will be supplied at completion of project and after full payment is received. ***100% payment is required for all non-current customers prior to testing. ***A non-refundable deposit of $100 may be requested prior to scheduling the testing. This deposit will be applied towards final invoice. ***The above rates are based on site locations within 30 miles of R. M. Dalrymple’s Office. For locations outside of the 30 mile range additional travel charges will apply. ***All prices subject to change. CAPTCHA Email This field is for validation purposes and should be left unchanged.