Title Page

  • Contract no. And Contractor

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Works Commencement Date

  • Planned Wastewater Completion Date

  • Actual Wastewater Completion Date

  • Was the Wastewater completion date achieved?

  • Planned Water Main Completion Date

  • Actual Water Main completion date

  • Was the Water Main completion date achieved?

  • Planned CPC date

  • Were any defects identified for re-work?

  • Actual CPC Date

  • Was the planned CPC date achieved?

  • Additional comments

  • Add signature

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