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Home My WebLink AboutPermit Backflow Test 2008-2-7 (2) ~....:.,;.-'I.',,"~' ~"'. ..... -.' ". ~' . , , , . , .' " . . , . ,'. . PNWS-~YJWA 0( '\ . ~ -. J, 771544 ,P~OPERTY OWNER: , M~ILlNG . ' ~;:', : ~DRESS: ' . CITY 5'P ~ d',~",:, STATP ~r ZIP ,? ;J7/ 76 '~~~R~~~~ '3 2~g-b ~) -I-Z;-'; ':',:,:J"':,\;,i>i' . STREEJi _, ,g~i~1~~1$(rD.c.v,A. 0 ~.P.D.A Dp.C.DA ~~.v.B,ADs.V.BA 0 A.V:!!:; 0 AiR GAP " ,,!;S'Iit:(i~fi;: 1/1~,2i-t'1 MAKE: Fd. d) . MODEL: /6 5 ,~if~I~~i:";;': S' tI g' / ~t~~R: II -S-S/Lfc/ ~ ~;:'~:ASSE~BLY . /': - ,/ .' 1 ' ::;~:;JtO:€~:rION: " ~ /- I- 5,1 0'/ 'c!' . .r) d a s-e.. .~,.,:~, :7./.".:;..'..- ", - - ~r:g]!lEW ( , 0 EXISTING , BACKFLOWASSEMBli\'TESTREPORTDREMOVED :, '.'; '.,0' . ' ". / ,., ..., '0 REPLACEMENT - 1~ '~/d t'#tJ."e, PHONE. or,' :: It'.~ 'REDUCED PRESSURE ASSEMBLY P.V.BA I S.V.BA INITIAL T~T . . Nl CHECK / ~~~~lli.liii!GfreCK;:; AIR CHECK PASSED )I!l . PRESS DROP "', (A)I . CHEC~~#l " INLET F,AILED 0 INITIAL RE[.J~F Yi\I,VE. (B)ITIGHT. D. OPENED AT: PRESS I?ROP. , "'. .. ",TEST OPENED AT MIN 2 PSID, ' " .' .' '. PSIDr.'; 7""7. 6." 2 :.A" . DA,TE.. .: .J7.,:"..-.,~ ,;RESULTS . ,,~I'.. \, ,LEAKEp~",,:,;~,:~';f: ..'...i.J:y....z:..1 7 I~' ',~ r BUFFE~" .~J ." ~f:':H' ro" ~ " PSID, PSID , ,,' (it ; A - B -'," . I I CHJ;:\::iJ~: #2 ..J;'~ . . , . , , , MIN 3 PSI ITIGHT''/O "}.,i" "DID' NC5'T FAILED- ~SYSTEM RELIEF. VAl:VE ' ".; ,~~ OPEN 0 ' '0 PSI-... PASS 0 FAIL 0 ILEAKEDD ,;}'.':: ""- ~ , \ :iI' COMMEIm REPAIRS AND/OR PARTS .. - ---.......- _,~ ....'w,_. , REDUCED PRESSURE ASSEMBL Y " NICHECK ~Qp.V'im""" p'!lESS DROP (A) CHECK/II" - ,RELIEf ' I, OPENED AT p,RESS DROP OPENED (B) .TIGHT 0 PSID BUFFER:'." ....,.."", i CHECK #2' ..~ A, B- I 0 PASSED ,........ TIGHT, PSID 'J PSID " PSID . IN COMPLETING AND SUBMrmNG llilS TEST RJ::PORT, lliE TESTE: CERTIFIES lliAT lliE . , ASSEMBL of HAS 'BEEN TESTED AND MAINJ"A1NED" IN ACCORDANCE wrrn ALL APPLICABLE , . """ 'RULES AND REGULATIONS OF TIlE WATER: SYSTEM, AND STATE REGULATIONS, f.~.;' G~UGE'CA~I~~..A;I~N DAT~~:~~ L2 DEn:CT~R METERJ.R> ADING . -. " ,~~)L-y./.~ -- . ,. .' TESTER SIGNAlURE~<" , -: . "c;7 r ~~; ..:' '- ' " . William W* KiilQslev II '0;,;:~tESTERSNAM,EPRINliD .PO'8Qx-114~2 E~g. OR 97401 , <~~"RS'AD~~ES~" ",\ "C1'':'I~~~'';~:',.;ietti.:..,1:--' CO~P~Y NAME" ' , ~. . ....._ ;k P,V.B,A.lS.V,B,A. " AFTER REP AI,RS DATE: . , "- " TEST: AFT~R REPAIRS / / o -"'~-::---:-- ," , 1041 CERH. .03061033tiAUGE . . . 7~~5(j1~ 'P-H~~E" . ;~ ,'\": <"';"",. . i . ;,0' S.ERR7~ .R.:E~"I~'R1Q:: -:' .j " frrf(;)'. '.. \i,~LLOW~;~ C, .~.. ,:.',:c :,' . ~~ ..;',:..... . ;. ""f " , REPORTR~CEI,VED BY: ":"',,:::; (ilEP~ESEbA1iVE OF OWNER)J, _~ ... . ~ .~. ~ ,..,,~, _~. .~W~ . '.",_ _." , yiHITE :'W'lerS~:CoPY; ~~~ PINK - Customer ~y ,- ~ .... .. r .. ""'"'--.-............. -'. .. ,- " jJ .1..,..