WATER SYSTEM INSPECTION RECORD Name and address of farm: _______________________________________________________ Date Time Source Observations Corrective Initials or Actions Taken Distribution System 10/11/17 2:00pm Well 1, north Well casing in good shape, None FR field backflow preventer in place, no broken pipes Reviewed by:_______________________ Title:_________________________ Date:_______ FSMA PSR reference § 112.50(b)(1)
WATER SYSTEM INSPECTION RECORD Name and address of farm: _______________________________________________________ Date Time Source or Distribution System Observations Corrective Actions Taken Initials 10/11/17 2:00pm Well 1, north field Well casing in good shape, backflow preventer in place, no broken pipes None FR Reviewed by:_______________________ Title:_________________________ Date:_______ FSMA PSR reference § 112.50(b)(1)