Flow Test Request
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1Emergency Prevention Division
Travis County Emergency Services District 9
248 Addie Roy Road, Suite B-103 – Austin, TX 78746
Mailing Address: P. O. Box 162170 - Austin, TX 78716-2170
Headquarters: (512) 539-3400
Fax: (512) 327-2780
Request for Flow Testing of Hydrants
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ESD Area: ESD # 9
Date of Request: _____________________
IMPORTANT INFORMATION - PLEASE READ
The Emergency Prevention Division will provide test results for the location listed on this form. There may be a $100.00 fee for
conducting this test. It is the requesting party's responsibility to ensure that the information is appropriate to the location of your
project. If available, we will provide you with information on file up to three years from the date requested. No fee will be charged
for pulling records from files. Information provided is an indication of the water supply characteristics in the immediate area on the
date and time noted. The Emergency Prevention Division does not guarantee that this data will be representative of the water
supply characteristics at any time in the future. Please supply an 8 ½ x 11 copy of the area needing to be tested with the water
lines and hydrants shown and designate the hydrants that are to be used.
Requesting Company Information
Company Name:
Company Address:
Street Address
Suite No.
City
State
Zip Code
Contact Person:
Phone Number:
Fax Number:
E-Mail Address:
Project Information
Project Information
Project Name:
Project Address:
Street Address
Suite No.
City
State
Zip Code
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Purpose for Testing:
Sprinkler / Standpipe System
Required Fire Flow
Requested Flow Test Location
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Hydrant Number:
Main Size :______________ Dead End Main?
Yes
No
Unk
Hydrant Address:
Block #
Dir
Street Name
Type
Cross Street:
Block #
Dir
Street Name
Type
Use only if close to hydrant
Hydrant Location (if other than street address):
Special Instructions (if needed):
Printed Name of Applicant
Signature of Applicant
Date
Emergency Prevention Division Use Only
Date Received: ___________ Date Completed: ____________ Completed By: _______________ Date Returned: __________
Fee Due: ____________ Amount Paid: _____________ Check Number: ______________ Date: _______________________
C
Comments: _____________________________________________________________________________________________
Revised 02/12
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