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Pump and Alarm Verification Form <br />Site Address: C q p W.,,+ `"+�►-� (Zoc-j <br />Company Name: 5 i►, "+ C rb -i x 5"-'c'r License #: 3 q T7 <br />1. That a representative or I of my company has verified that the Indoor or Outdoor Pump Alarm <br />sounded by lifting the float switch and the alarm light is on and that the pump was tested with <br />the float switch. <br />2. If applicable, that myself or a representative of my company has verified that the Indoor or <br />Outdoor Filter Alarm sounded by lifting the float switch and the alarm light is on. <br />Date: <br />Print Name: <br />Signed: <br />Please upload to your permit in Citizenserve when completed. <br />Final Inspection and certificate of compliance cannot be issued until this form is received. <br />