HomeMy WebLinkAboutPermit Backflow Test 1978-05-05)11,i .'',f : ;
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BACKFTOW PR.EVENTION DEVICE TESI R.EPORT
FIRM
NAME:
DEVICE
ADDRESS:
DEVICE
SIZE:
DEVICE
LOCATION:
INITIAT
REPAIRS
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PAfrTS
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AFTTB
REPAIR
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TEST
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INITIAL TEST
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FAILED tr
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AFTER REPAIR
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DETECTOR METER READING
IN COMPLETING AND SUBMITIING THIS TEST REPORT, THE TESTER CETflFIES THAT THE
DEVICE HAS BEEN TESTED ANO MAINTAINED IN ACCORDANCE wlTH ALL APruCAELE
RULES AND BEGULANONS OF TH€ IA'AIER SYSTEM OA/NER AND THE STATE OF OREGON.
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DOUBLE CHECK VALVE
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BREAKER
CHECK #1 CHECK *2 AIR INLET CHECK
PRESSURE DEVICE
CHECK #1
PRESS DROP
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LEAKED E REUEF VALVE
PASSED
FAILED D
OPENED AT
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D[) NOT
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PRESS DROP
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LEAKED
'1 PRE$S DROP
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REUEF OPEN
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OPENED AT
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PflESS DROP
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TIGHT D
LEAKED D