Efficiency Test
Service Authorization for Pumping System
Customer or Authorized Agent Customer Number
Address City, State, Zip Code
Customer Contact Office Phone / Other
Reason for Test E-Mail Address
Can the pumps be tested any time?
Yes No
Preferred month for test:
Is this reclaimed water?
Yes No
Has the pump been repaired or adjusted since last test?
Yes No
Pump Last
Test Date
Pump Name Service Location / Nearest Cross Street
Service Account
Number
Meter
Number
HP
Rate
Schedule
Standar
Standar
d
d T
T
er
er
ms and Conditions Pumping S
ms and Conditions Pumping S
yst
yst
em Efficiency
em Efficiency
T
T
est
est
1. AGREEMENT TO PERFORM SERVICES. Edison is willing to perform the Pumping System Efficiency tests (the “Services”),
authorized by the Service Authorization on the terms and conditions herein. In performing the Services, Edison will, if equipment
configuration allows, measure the total head, flow rate, and electrical power input of designated pumping equipment using
standard instrumentation and, based on such measurements, calculate the efficiency of such pumping equipment and deliver
written test results to Customer. In no event shall any Services include any repair work on any pumping equipment or other
property of Customer.
2. LIMITATION OF SERVICES; WARRANTY DISCLAIMER. Edison will perform all services in accordance with standard test
procedures and technical practices. No other warranty or guaranty is made concerning work performed under this agreement,
including the pumping equipment tested and the accuracy of Edison’s reported results. Customer accepts the responsibility for
their choices to use Edison’s work and/or to take other actions to test or repair the equipment. CUSTOMER AGREES THAT EDISON
MAKES NO WARRANTIES WHETHER STATUTORY, EXPRESS, OR IMPLIED (INCLUDING ANY WARRANTIES OF MERCHANTABILITY
AND FITNESS FOR A PARTICULAR PURPOSE AND ALL WARRANTIES ARISING FROM COURSE OF DEALING OR USAGE OF TRADE).
3. CUSTOMER RESPONSIBILITIES. Customer gives Edison permission and will arrange for Edison’s access to all public and private
property as required for Edison to perform Services. Customer disclaims any right to payment for any damage to Customer’s
equipment, crops or other property arising as a result of the Services, except for damage to the equipment being tested that
occurs as a direct result of Edison’s gross negligence.
4. OTHER GENERAL TERMS. The Services are subject to modification by the Public Utilities Commission of the State of California.
Return To
Sandy Gabriel
300 N. Pepper Ave. Bldg C
Rialto, CA 92376
Email this form by selecting “Email” below.
Email
Phone: 909-820-5519
Fax: 909-820-5631
Customer has read and agreed to the terms of this report. Customer authorizes Edison to
perform the pumping system efficiency test on the pumps described above and on the
following pages, subject to these terms and conditions. The terms on this sheet, front and
back constitute the entire agreement between Customer and Edison.
Signature Title
Name Printed Date
