Affidavit of Meter Calibration Test

Harris-Galveston Subsidence District 1660 W. Bay Area Boulevard Friendswood, TX 77546-2640 Phone: (281) 486-1105 Fax: (281) 218-3700

Permittee Name:

Well No.

Description of site at location:

Meter Manufacturer:

Serial No.:

Type:  PropellerTurbinePositive DisplacementCompoundOther

Testing Firm:

Mailing Address:

City    State:    Zip:

Phone Number:          Ext.:

Test Supervisor:

Title:

Details of Test:  Pitot TubeTransmit TimeIn-Line Calibrated Meter

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 ÷ item 4 x 100)

Flow Rate:

Recalibration:  YesNo

Percent Accuracy after Recalibration:

Remarks:

Applicant/Agent Name:

Please enter your e-mail address:
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