Fillable Contractor/Subcontractor Page 1 of 5 (City of Vaughan)

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Contractor/Subcontractor Page 1 of 5 (City of Vaughan)

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The Contractor/Subcontractor Page 1 of 5 (City of Vaughan) form is 5 pages long and contains:

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Contractor/Subcontractor Page 1 of 5
Site Summary
Site Name & ID: ________
________________________________ Phase #: _______ City Block #: ______
Name of the Proponent:__________________________________
Developer:________________________ Consulting Firm:_____________________
Contact Name:______________________ Contact Name: ______________________
Contact Number:____________________ Contact Number: ____________________
Contractor (General): _____________________ Contractor (Commissioning): ___________________
Contact Name: __________________________ Contact Name: ______________________________
Contact Number: ________________________ Contact Number: _____________________________
Commissioning - Operator information
Full Name
Operator ID
(OWWC)
Signature
Initials
Operator In Charge for the
Project
Operator #1
Operator #2
Operator #3
Operator #4
Operator #5
Live Taps
Nu
mber of Live Taps: 1 2 3 4 5 N/A or Specify: _______
Pe
rformed by (Contractor): _____________________________________________________________________
Date(s): _____________________________________________________________________________________
Water Meter
Wa
ter Meter Serial #: ____________________ Model #: __________________________ size: __________
Me
ter Reading @ Start: _____________________________ (m
3
)
Final Readings @ Completion: _________________________(m
3
)
Total Usage: ____________ (m
3
)
Contractor/Subcontractor Page 2 of 5
Site Summary
Backflow Prevention Device Summary
** ONLY CSA-CERTIFIED REDUCED PRESSURE (RP) BACKFLOW PREVENTERS SHALL BE USED **
** INSTALLATION AND TESTING REQUIREMENTS SHALL BE IN ACCORDANCE WITH CSA STANDARDS B64.10 and B64.10.1 **
DAY 1 - INSTALLATION INFORMATION
SN: ___________________ Model: ___________________ Size: ____________
Location of Installation: ___________________________________________________________
Date Installed/Tested: ____________________________________________________________
Tester Name: _______________________________________ CCCS #: ______________
Day 1 - Relocation #1 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: ______________
Day 1 - Relocation #2 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: _______________
DAY 2 - INSTALLATION INFORMATION
SN: ___________________ Model: ____________________ Size: ____________
Location of Installation: ____________________________________________________________
Date Installed/Tested: _____________________________________________________________
Tester Name: _______________________________________ CCCS #: ________________
Day 2 - Relocation #1 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: _________________
Day 2 - Relocation #2 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: _________________
Contractor/Subcontractor Page 3 of 5
Site Summary
DAY 3 - INSTALLATION INFORMATION
SN: ___________________ Model: ____________________ Size: ____________
Location of Installation: ____________________________________________________________
Date Installed/Tested: _____________________________________________________________
Tester Name: _______________________________________ CCCS #: __________________
Day 3 - Relocation #1 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: __________________
Day 3 - Relocation #2 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: __________________
DAY 4 - INSTALLATION INFORMATION
SN: ___________________ Model: ____________________
Size: ____________
Location of Installation: ____________________________________________________________
Date Installed/Tested: _____________________________________________________________
Tester Name: _______________________________________ CCCS #: __________________
Day 4 - Relocation #1 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: __________________
Day 4 - Relocation #2 Summary
Located to: ______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: __________________
DAY 5 - INSTALLATION INFORMATION
SN: ___________________ Model: ____________________ Size: ____________
Location of Installation: ____________________________________________________________
Date Installed/Tested: _____________________________________________________________
Tester Name: _______________________________________ CCCS #: ___________________
Day 5 - Relocation #1 Summary
Located to: ______________________________________________________________________
Contractor/Subcontractor Page 4 of 5
Site Summary
Certified Operator in Charge of Relocation: _______________ CCCS #: _________________
Day 5 - Relocation #2 Summary
Located to: _______________________________________________________________________
Certified Operator in Charge of Relocation: _______________ CCCS #: _________________
Swabbing
Number of Watermain Swabbing Round(s): 1 2 3 4 5 N/A
Date(s): __________________________________________________________________________
Turbidity
Number of Turbidity Round(s): 1 2 3 4 5 6 7 8 or Specify:_______
Date(s): __________________________________________________________________________
Hydrostatic Testing (Pressure Test)
Number of Hydrostatic Pressure Test Rounds: 1 2 3 4 5 or Specify: _______
Date(s): __________________________________________________________________________
City of Vaughan Pressure Test #: ______________________________________________________
Chlorination
Number of Chlorination Rounds: 1 2 3 4 5 or Specify: _______
Date(s): __________________________________________________________________________
Contractor/Subcontractor Page 5 of 5
Site Summary
Chlorine High Count Results – Contact Time (Minimum 24 hrs. to Maximum 72 hrs.)
Number of Successful Rounds: 1 2 3 4 5 or Specify: _______
Date(s)___________________________________________________________________________
Number of Unsuccessful Rounds: 1 2 3 4 5 N/A
Date(s)___________________________________________________________________________
Dechlorination/Flushing History
Number of Flushing/Dechlorination Round(s): 1 2 3 4 5 6 7 8
or Specify: _________
Date(s): __________________________________________________________________________
Microbiological Sampling
Number of Sampling Rounds: 1 2 3 4 5 6 7 8 or Specify: _______
(Note: Each Round contains 2 sets of samples)
Final Connection/Closure Piece
Total Number of Final Connections/Closure Piece: 1 2 3 4 5 or Specify:_______
Comments:
Representative Name: _____________________________________ Signature: ____________________
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ContractorSubcontractor Page 1 of 5 (City of Vaughan)

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Completed 9 May 2021

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