Hot Box Enclosures (CA07145E)

Hot Box Backflow Checklist Print Form Reset Form Custom Enclosure Backflow Prevention Equipment Checklist Please fill out completely and send to your local manufacturer representative or customer service representative: Please fill out completely.

Single Line Installation Type: Dual (Manifold) Tandem (2 Separate)

12" Bottom Clearance Installation Height: 18" Bottom Clearance 30" Center line Other:

1/4" Pipe Size:

Valve Type: QT OS&Y NRS

Ames Backflow Manufacturer: Apollo/Conbraco

1/2"

3/8"

5/8"

3/4"

1"

Febco Watts Wilkins

1-1/4"

1-1/2"

2"

Butterfly Valves

Pump (see below)*

2-1/2"

3"

4"

Other:

Other:

6"

8"

10"

Model #:

12"

14"

16"

18"

20"

24"

Other:

Varies (please explain)

Other:

Custom Aluminum Enclosures

Please continue for meters or additional backflow device:

Ames Backflow Manufacturer: Apollo/Conbraco

Badger Meter Manufacturer: Elster Hersey Master Meter

Meter Type: Compound

Strainer Type: Wye Plate Basket

Valve Type:

QT OS&Y NRS Butterfly Valves

Metron Farnier Neptune Sensus/Omni

Fire Line Turbine

Febco Watts Wilkins

None

Other:

Model #:

Model #:

Other:

Other:

Additional Equipment:

Additional Requirements (Please be specific):

Altitude Valve

Meter Bypass Check Valve

FDC (Siamese) PRV

Pump Enclosures:

Wafer Check Valve Solenoid

*Note: If quoting to enclose a pump or pumps, please include pump dimensions or attach specifications to this form. Also, please include clearances.

Test Tee

Other:

Model #:

Job Name:

Job Location:

Engineer/Contractor:

Phone:

Fax:

e-mail:

Distributor:

Phone:

Fax:

e-mail:

Representative:

Phone:

Fax:

e-mail:

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