HomeMy WebLinkAboutBuilding Compliance Report 2014-1-28 � 1494336
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❑EXISTING
aNws� 9 BACKFLOWASSEMBLYTESTREPORT ❑REMOVED
_J /�j y,// ❑REPLACEMENT
PROPERTY AJv SI A-, 34 //
OWNER: (J PHONE:
MAILING
ADDRESS:
CITY �j ./ -�S"TATEE ' / ZIP /�. J{
ASSEMBLY ADDRESS: /r 3 1-A obi 7 /. , 3p/?/N4i laic
STREET
❑R.P.B.A.lir D.C.V.A ❑ IL P.D.A ❑D.C.D.A ❑P.V.B.A ❑S.V.B.A ❑A.V.B.
0 AIR GAP
SIZE: I It ID.AI MAKE: &Od-3gll-60 MODEL: V 6%1
WATER C
PURVEYOR: I/g 1/? l u N
NUMBER:
ASSEMBLY 11�� �
LOCATION: /A &c Srfto ., 5/4C /3 Y G46V. 8�
REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A INITIAL TEST
II CHECK '`DOUBLE+CHECK°_ AIR CHECK PASSED
PRESS DROP (A)1 CHECK #1 INLET I FAILS ❑
INITIAL RELIEF VALVE
TEST OPENED AT (B)ITIGHT fr2./ OPENED AT. PRESS DROP DATE:
RESULTS BUFFER '
wIN2 PSID LEAKED❑ �D / j/6///
A-B= I CHECK #2
PSTD PSID
MIN]PSI DID NOT FAILED SYSTEM
RELIEF VALVE (TIGHT —r/
PASS ❑ FAIL ❑ !LEAKED❑ PBD OPEN ❑ ❑ PSI
COMMENTS '
REPAIRS
AND/OR
-PARTS
' REDUCED PRESSURE ASSEMBLY - P.V.B.AJS.V.B.A. AFTER REPAIRS
NI CHECK (A)! ' 4 DCltA°k-' DATE:
PRESS DROP
TEST REUEF (CHECK HI _ OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT ❑ PEED / /
REPAIRS Bunn M.• 'CHECK 112 '
w-e- ...„a ITGGHT ❑ Iwo . nip PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT.THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM. AND STATE REGULATIONS.
GAUGE CALIBRATIO�N TE 2. /� DETECTOR METER READ@ifr'----
•l 5088
TESTER SIGNATURE 7 I Cralg Morgan 803(1395
--TESTERS NAME PRINTED D KPLOW Cf CCIALTICE GAUGE I
P O Box 21824 Eugene OR 97402
TESTERS ADDRESS 541-345-0152 PHONE I
I l-a w
C ` �`N7 (\A ‘5))17t54--- - SERVICE RESTORED
REPORT RECEIVED BYI Y ' - ' (REPRESENTATIVE OF OWNER)
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