Guide of Site Survey on Water Refilling Station

Name of Water Refilling

Station
Address
Name of Owner
Contact Number

Source of Raw Water Water District or Private?

If source of water is not from Water District,
Spring or Well? ________________
If well
 please indicate the depth of the well: _____________________
 Please provide draft sketch of the location of the well, refilling station and all
possible source of pollution such as septic tanks.
Equipment Please provide a copy/ photo of Certificate of Health Related Device Registration issued
Manufacturer/Supplier by FDA, if available.

For Plan as Built: (Draft will do, please provide dwg file if possible)

1. Perspective View (Photo will do)

2. Location map
3. Floor Plan with the Equipment Layout
a. Please indicate the location of Raw and Product water tanks
4. Plumbing Layout

Photo: wide lens shot preferably

1. Front
2. Perspective
3. Inside: Equipment, countertop, lavatory
4. Septic tank and other possible source of pollution
5. Outside
6. Please also provide screenshot of the location via google map