HomeMy WebLinkAboutPermit Plumbing 1987-9-17
FIRM
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BACK FLOW PREVENTION DEVICE TEST REPORY-/ L::Y/
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~ REDUCED PRESSURE DEVICE ~ PRESSURE VACUUM I
INITIAL TEST '~
I DOUBLE CHECK VALVE I CHECK * 1 BREAKER PASSED .".
1 CHECK *, CHECK *2 I I AIR INLET CHECK I FA'LED 0;
P,9ESS gBOP I _,r
I, ibJ.L\::'"" I OPENED AT ""ESSDRDP DATE~/L3...i~
'~~ jTIGHT ., 1lGHT . fI~~EO AT I
RELIEF VAL: I LLJeUI'SII LlJeUI'SIl
I LEAKED 0 LEAKED 0 PASSED. DID NOT
\ LEAKED
II FAILED 0 II OPEN 0
1
REPAIRS I
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TEST I
AFTER I1lGHT
REPAIR
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TIGHT
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. "1 PRESS DROP ~
LLJeUPSl[l ! OPENED AT
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REUEf-OPEN
:LUeUPSIJ
LlJeUI'SII II
AFTER REPAIR
""ESS DROP 1 DATE.LU/LU/LU
LU'U"" II
DETECTOR METER READING
IN COMPLETING AND SUBMIT1lNG llilS TEST REPORT, lliE TESTER CERTIFIES lliAT THE
DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF lliE WATER SYSTEM OWNER AND lliE STATE OF OREGON.
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GAUGE"
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CERT"
By-a:- /~ (REPRESENTATIVE OR FIRM)
. . . ,. '\ ~TlFY. TI-lE ABOVE TEST HAS BEEN PERFORMED
WATER SYSTEMS COpy