Form QT 9 PU (A) 36 Page 1 Of

form qt 9 p.u. (a) 36 page 1 of 2 eleventh schedule [subrule32(2)] water services industry act 2006 water services industry

Form QT 9
P.U. (A) 36
Page 1 of 2
ELEVENTH SCHEDULE
[Subrule32(2)]
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (WATER RETICULATION AND PLUMBING) RULES 2014
CERTIFICATE OF DISINFECTION
(For Demand <50,000 liter per day / >50,000 liter per day*)
Date
:
To
:
Detail of premises
:
Sir,
We refer to the above named Development Title and to your application
for the handing over of the external water reticulation system/supply
main* dated …………………………….
I/We certify that I/we have carried out disinfection exercise on all
new and/or altered water fittings of the above premises on
……………………………. and that to the best of my/our knowledge and belief such
work(s) is/are in accordance with the requirements of the Water
Services Industry (Water Reticulation and Plumbing) Rules 2014 and
I/we accept full responsibility accordingly.
Permit holder
Name
:
Address
:
Registration No.
:
Type
:
Form QT 9
Page 2 of 2
SUPPORT LETTER FROM DISTRICT WATER QUALITY DEPT FOR STERILIZATION,
DEWATERING, FLUSHING AND WATER QUALITY TESTING ACTIVITIES
Name Of Development
:______________________________________________________
:______________________________________________________
Project Reference No
:______________________________________________________
Date Of Inspection
:______________________________________________________
……………………………………………………………………………………………………………
We refer to the above development and the water quality test and
inspection were completed on the ________________________ .
We certify that sterilization, dewatering, flushing and water quality
testing activities were completed at the above mentioned development
and in accordance with the requirements of the Water Services Industry
(Water Reticulation and Plumbing) Rules 2014 and AIR SELANGOR
standards and specifications. We also certify that all amount due from
developer to AIR SELANGOR in connection with sterilization,
dewatering, flushing and water quality testing activities has already
been paid to AIR SELANGOR and we accept full responsibility
accordingly.
Inspected by : Supervised by :
…………………………………… …………………………………..
Signature of Signature Of AIR SELANGOR
Competent Person Executive/Technician
Water Quality Unit
Name :
Firm : Name :
CP Registration No : Staff No:
NRIC No : Date :
Date :
Approved By :
……………………………………..
Head Of Region/Technical Manager
Regional Development Unit
Date :