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: $205.60 Quantity: Tank Sumps Price: $205.60 Quantity: Spill Buckets Price: $52.74 Quantity: Overfill Valve Price: $52.74 Quantity: Total $0.00 Please note, above total does not include Tax.Clauses: ***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.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.