HomeMy WebLinkAboutBuilding Plumbing 2014-2-3 Aar', 1475685
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ENE w
p ,A i ❑EXISTING
w's'Ica B ACKF LOW ASSEMBLY TEST REPORT ❑REMOVED
❑REPLACEM
ENT
OPRWNOPEERRTY T)V tt \ 1
y/y/� PHONE:
MAILING
ADDRESS: I 1 �5 2 ^C /c ( /y/� / ^�
CITY �y J ( C/1 STATEIJ? ZIP1 !`-I I
ASSEMBLY /�}F �� `� _
ADDRESS: -� v`i1 1 .
STREET
❑R.P.B.A. ❑ D.C.V.A. ❑ R.P.D.A. ❑D.C.D.A. ❑P.V.B.A ❑S.V:B.A. A.V.B. 0❑/AIR�(GAP
SIZE: �•la� MAKE)): ��lX/f mil UD MODEL: I t LD /�L'1 SERIAL
PURVEYOR: / NUMBER- 32^9 to 1nel
ASSEMBLY
LOCATION: Vp V X V J\
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
II CHECK 1,DOUBLECIIECK7;; AIR CHECK PASSED fa
PRESS DROP CA)1 CHECK #4 ^/ INLET FAILED ❑
INITIAL RELIEF VALVE TIGHT ® L'
PSID(� OPENED AT PRESS DROP
TEST OPENED AT J B (
RESULTS BUFFER MIN 2 PSID !LEAKED❑ PSID PSID
� �
A-B= I CHECK
MIN JPSI ITIGHT K , DID NOT FAILED SYSTEM
RELIEF VALVE PSID OPEN ❑ ❑ PSI
PASS ❑ FAIL ❑ 'LEAKED a...1
COMMENTS
REPAIRS
AND I OR
PARIS
REDUCED PRESSURE ASSEMBLY P,V,B,A,/S.V.B.A. AFTER REPAIRS
II CHECK D.C.V,A n •
, PRESS DROP (A)ICHECK #1
DATE:
TEST
RELIEF _ OPENED AT PRESS DROP
I
AFTER OPENED (B) TIGHT ❑ PSID / I
REPAIRS 1°BUFFER 10 ICHECK #2 '
n-e-
..,,,a 'TIGHT ❑ PSID PSID PSID - PASSED ❑
IN COMPLETING AND SUBMITUNG THIS TEST REPORT,THE TESTER CERTIFIES THAT THE t
( ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WRH ALL APPLICABLE
RULES AND REGULA S OF EWAATER SYSTEM, AND'STATE REGULATIONS
/ .
'GAUGE CALIBRATION DATE U2FECTOR METER READING
' V
TESTER SIGNATURE CERTI
TEsTiERTMCGOTRDON 4315 GAUGE
,ES AI5 PEt ST SPRINGFIELD 01010745 PHONE
I
COMFQ ll&
SWINNC(f',lE PROTECTION 7MM-1775-
❑ SERVICE RESTORED
REPORT RECEIVED BT: [REPRESENTATVE OF OWNER) '
-j
W ITT-Water System Copy PINK-Customer Copy YELLOW-Tater Copy -