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HomeMy WebLinkAboutPermit Plumbing 2007-12-5 (3) .o~ PNWS-AWWA 874369 BACKFLOW ASSEMBLY TEST REPORT 0NEW o EXISTING o REMOVED o REPLACEMENT ~' RO. ,F.\!'.RTY / . ER: MA ING ADDRF~S: Mr k.u.., ~ ~I\d"a\\ A-.k PHON" CITY ASSEMBL V ADDRFli:Ii.":'. -"\ OhI:.J,M'O ~!:I~h~ S~- ~t-L, STAT' OA ZIP STREET 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. ~~~~R: ?-<f. ,,~Loq~ r-J \k' (,,,-ill. JCo..wD\~~ 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