Hydrostatic Testing Request Form Site Name*Site Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Site PhoneSite Contact Name First Last Contact PhoneContact Email Photos Drop files here or Comments, Questions, ConcernsOrderDispenser Sumps Price: $240.00 Quantity: Tank Sumps Price: $240.00 Quantity: Spill Buckets Price: $61.00 Quantity: Overfill Valve Price: $98.00 Quantity: Total $0.00 Please note, above total does not include Tax.CAPTCHAClauses: ***Customer is required to clean equipment (sumps and containment) prior to Dalrymple arriving to test. ***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 is required to 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.