1. The date the meter was found broken, malfunctioning or missing security seal.
2. The well or pumpsite location of the new meter.
3. If the meter was replaced, (a) the manufacturer, model, serial number, type of meter, and pipe size, of the new meter. (b) The totalizer register unit and multiplier factor of the new meter. (c) The totalizer reading of the new meter at the time of installation. (d) The well or pumpsite location of the new meter.
4. If the meter was repaired, the totalizer reading immediately before the reapair and the totalizer reading at the time the meter was reinstalled or the repair was completed on site.
5. The date the repair or replacement was completed.
6. The amount of water usage not metered.
Sign, date, and address the form. Submit to the appropriate field office or GMD within 30 days after the meter was repaired or replaced.