HomeMy WebLinkAboutPermit Plumbing 2007-12-5 (3)
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PNWS-AWWA
874369
BACKFLOW ASSEMBLY TEST REPORT
0NEW
o EXISTING
o REMOVED
o REPLACEMENT
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DR.P.BA 0 D.C.VA 0 R.P.DA OD.C.DA Dp.V.BA DS.V.BA OAV.B- o AIR GAP
_' SIZE: ~.M MAKE: \ ,.}! \ Vv\\.-.A
WATER ()
~URVEYOR: S. (1, It)
ASSEMBLY f\" . /"\
LOCATION: ~O'>l t\.u l"Ii.""r.. {eI
MODEL: C\ ')5 K L.
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REDUCED PRESSURE ASSEMBLY P. V.BA I S. V.BA INITIAL TEST
It! CHECK 1.~ "DOUBLE CHECK. AIR CHECK PASSED 0
PRESS DROP (All CHECK #1 INLET FAILED 0
INITIAL REL.lEF VALVE -'3.2 (BlITIGHT 0 OPENED AT: PRESS DROP DATE:
TEST OPENED AT . MIN 2 PSID ,LEAKED 0 PSID IJi5 1;)7
RESULTS BUFFER PSID PSID
A-B'" I CHECK #2
MlN3 PSI 0_
ITIGHT DID NOT FAILED SYSTEM
RELIEF VALVE PSlD OPEN 0 0 PSI
PASS 0 FAIL 0 ILEAKEDD
COMMEh"T'S
REPAIRS
AND/OR
PARTS
~\.~'''r-
-'P-
TEST
AFTER
REPAIRS
REDUCED PRESSURE AS'if.MBl Y
.\ CHECK (A I {1l~VA
PRESS DROP ). CHECK #1 I
RELIEF I _ OPENED AT PRESS DROP I I
OPENED (8) . TIGHT 0 PSID
BUFFER .mHPCID I CHECK #2 0
"-8- ) PASSED
_'os TIGHT 0 PSID PSID PSID..
IN COMPl..ETlNG AND SUBMrrnNG 1liIS . "... .....:........... ...f TESTE.~ CERTIFIES TliAT TliE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH All APPLICABLE
RULES AND REGULATIONS OF ll-IE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CAL~RATION DATE -::v ;}-- /O/DETECTOR METER READING .
y~ ~~ ""r::;::? .' //17
TESTER ""NA'Yl' ,_~ A.... rv"ldJ ()lfoEly'
TESTERSNAMtPRi.&p, f.!y,,, 'lC\r~(~ E~ O~."11:(b1 GAUGE'
TESTERSADDRESS1P- ? L of _~.... 0 I_A 1..:-- V .1-', ..: PHON"
COMPANY NAME . r V - '..t-;.
P.V.B.A./S.V.B.A.
AFTER REPAIRS
DATE:
REPORT RECEIVED BY:
-. t.., "[tSERVICE RESTORED
(R.EPR.ESE,,",Anv~ OF OWNER)
WHITE. W.ter System Copy
PINK. Customer COpy
YElI.OW. Tester Copy