HomeMy WebLinkAboutPermit Plumbing 1986-6-27
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JACK HUNLEY PLUMBING, INC.
367 Hayden Bridge Way
Springfield, Oregon 97477
746.6151
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BACKFLOW DEVICE TEST REPORT
U"'&/ ~~7"" eo
ADDRE~' / 9'o/-S - A-. S,f"./;7cA. (!)')'--{
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SIZE / 7". MODEL"7~5-:Y-.Fdc~ERIAL# <;? '7o~.3
O(>J-rt!cn.
LOCATION OF DEVICE, .r?) p.yyW,?? ~ ~ )",d,
FIRM NAME'
,
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lI>
W
....
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REDUCED PRESSURE DEVICES
DOUBLE CHECK VALVES l Prenure
I Drop ACfon
Chec'
,L./
PASSED,
FAILED:
Check
#,
Check
#2
lbo. TESTER,
1?iJ i/~
CERTIFicATION ,-
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Opened at
'''', ~b -,21,J~
PRe". /3)"<::-&,0'<:.-r-
_;1..'7,
Luked
L......,
Closed
Tight
Closed
Tight
Reli.f
I ,
I ,
Valve
N~Parts
and/or
Aepllirs
Made
If Needed
/?eS S
Iff,
Final Test
Alter
Repairs
C!l'~k C~e1k Relief TESTER #
Ctosed Closed Valve
rIght Tight Opened at NAME,
( ) I I
.Ibs.
DATE:
I CERTIFY THE ABOVE TeST HAS BEEN PERFORMED.
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BY; ~ A MLU'1../1
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ICOMPANY OFFICER)
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JACK HUNLEY PLUMBING, INC,
367 Hayden Bridge Way
Springfield, Oregon 97477
746-6151
) ,rJ2,;.J
V 3?3
BACKFLOW DEVICE TEST REPORT
r!~e:??-7
ADDRESS, / Yo / - <5, rJ,
C'c7 '
(S'~/, CJ,-~
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SIZE % ~'MODEL 9o'?&.?1l SERIAL# P'7~C 0-
LOCATlONOFDEVlCE::;<n /;;k ~o.,,?::e J R=?'1
~
FIRM NAMF'
Pr:1<.,/
REDUCED PRESSURE DEVICES
PASSED:
DOUBLE CHECK VALVES P,enure
Drop Across FAILED,
.... 'Check Check ~1>'
lI> #1 #2 TESTER:
w lbo,
....
-' Le.ked L......, 77/-ey:
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~ ERTIFICATION
Closed Closed Reli_f #A.-?6-/
Tight I I Tight. ( I Valve
Opened ar DATE 6' - c2 7- 6;;
"3. -Y '''',
New Par..
.nd/or
Repllin
M....
If Needed
,L7,.ff /3-.. '0 -
Y, 7'
Final Test
After
Repairs
C!l'~' C~r Relief TESTE R #
Closed Closed Valve
Opened at NAME:
Tight Tight
I ) I I
IbI.1 DATE:
I CERTIFY THE ABOVe TEST HAS BEEN PERFORMED.
BY /f A (ld /.'_<"-/1
&/.:2?/ p~
(COMPANY OFFICERl
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