HomeMy WebLinkAboutPermit Plumbing 2007-12-5 (2)
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874370
. BACKFLOW ASSEMBLY TEST REPORT
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o REPLACEMENT
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ASSEMBLY
ADDREII;!~.
STREET
dR.P,B.A,O D.C.VA 0 R.P,D.A OIl.C.DA OP,V,BA DS.V,BA 0 AV,B, o AIR GAP
SIZE: u!J.,OIC, MAKE \A/dl\\() '\ MODEL' q)5 XL
WATER "'l..IAf2. SERIAL '2".,/lq'
PURVEYOR: -JvlU NUMBER: 0<. I:> "'-
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P.V.BA I S.V.BA INITIAL TEST
AIR CHECK PASSED 0
INLET FAILED 0
OPENED AT: PRESS DROP (.)
DATE:
/)./5 o?
P51D ~ I PSID
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DID NOT FAILED SYSTEM
OPEN 0 0 PSI , "
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REDUCED PRESSURE ASSEMBLY
" CHECK <.:l 2. I DOUBLE';CHECK
PRESS DROP (j, (A I CHr:cK #1
INITIAL RELIEF VALVE 3 J J (BlITIGHT 'D
TEST OPENED AT n -P"D
RESULTS MIN 2 PSIU ILEAKED 0
BUFFER 4 8
A - B ~ , I CHECK #2
MIN 3 PSI
RELIEF VALVE ITIGHT 0_
PASS 0 FAIL 0 ILEAKEDD PSlD
COMMENn
REPAIRS
ANDIOR
PARTS
TEST
AFTER
REPAiRS
REDUCED PRESSURE ASSEMBI.Y P. V.B.A.lS. V.B.A
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RELIEF I CHECK #1 _ OPENED AT PRESS DROP
OPENED (B) TIGHT 0 PS1D
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BUFFER CHECK #2
A-8" .....,.,. JTIGHT 0 PSID P810 PSID
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IN COMPLETING AND SUBMrmNG nus TEST RJ:::PORT, TIiE TESTE' CERTIFIES 11iATllIE
ASSEMBLY HAS BEEN TES'11:D AND MAINTAINED iN ACCORDANCE wrrn AL} APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM. AND STAn REGUJ.:ATIONS.
GAUGE CALIBRATION DATE ":JI ).. /:>? DETECTOR METER READlNf'
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TESTER SlG/Z~ ~~ O(r_c;~'
TESTERS NAME PRINTED GAUGE .
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AFTER REPAIRS
DATE:
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PASSED 0
1
TESTERS ADDRESS
PHONE 1/
COMPANY NAME
REPORT RECEIVED BY
n C',ERVICE RESTORED
(REPRESENTATIVE OF OWNER)
WHITE . w.ter System Copy
PINK. C\lStomef Copy
YELLOW. Tester Copy