HomeMy WebLinkAboutPermit Plumbing 1987-6-25
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, I INITIAL JEST
, I DOUBLE CHECK VALVE I CHECK # 1 BREAKER PASSED it
I CHECK # 1 CHECK #2 I I AIR INLET CHECK I rAILED 0
I PRESS DROP r,
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: REUEF VALVE
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PASSED 0
FAlLED 0
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BACK FLOW PREVENTION DEVICE TEST REPORT I-; 7 d--.
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FIRM
NAME
DID NOT
OPEN 0
LEAKED
REPAIRS
AND/OR
PARTS
TEST
AFTER
REPAIR
I "1 PRESS DROP I
LLJ.UPSlD OPENED AT
I REUEF OPEN 'I ' , ,
L..L..J.UPSlO
Uj.UPSIO
LLJ.UPSlO I
TIGHT 0
TIGHT 0
I AFTER REPAIR
PRESS DROP I DATE Ll.J/Ll.J/Ll.J
DETECTOR METER READING
IN COMPlETlNG AND SUBMITTlNG THIS TEST REPORT THE TESTER CERTlF1ES THAT THE
DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATlONS OF THE WATER SYSTEM OWNER AND THE STATE OF OREGON
~ ~ to03 B-:3VG
/ TESTERS SIGNATIJAE GAUGE <# CEAT #
BY ~~/ ,~---#, IREPRESENTATIVEORF'RMI
, CE~,^ THE ~~ST t=-lAS BEEN PERFORMED
V WATER SYSTEMS COPY