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Home My WebLink AboutPermit Backflow Test 1987-02-02OijBt) sililisol{ PLlil,li-l>-'i :l:'1;i '!' ii{c 1293 3Ci'1'"{ Slii':tl EUG'ri:E, CREGCN 97t02 (il€(FtBLv pREvENTtoN DEvtcE rEsr REPoR.T FIRM NAME: DEVICE ADDRESS: DEVICE SIZE: DEVICE LOCATION: INITlAI REPAIRS AN0,/08 PAfrTS IEST AFTER REPAIR '.'74 DEVICE MAKE: CITY Q,l.tuG , , *oo,, J sennl@ltuuaen ITST INITIAL TEST -/passeo { FAILED tr ,onE,l-&r8J 6 42, a?7o GAUGE # CERT * AFTER REPAIR oATE:l ill/l llll ll DETECTOR METEB BEAOING IN COMPLENNG AND SUBMITTING THIS TEST REPORT, THE TESTER CETNFES THAT THE DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WTH ALL APruCABLE RULES AND REGULANONS OF THE IA'AIER SYSTEM OWNER AND THE STAIE OF OREGON. PRESSURE VACUUM BREAKER CHECKAIR INLET REDUCED PRESSURE DEVICE DOUBLE CHECK VALVE LEAKED ELEAKED D TIGHT TIGHT I CHECK #1 CHECK # 1 CHECK #2 DROP I I lo[-] pso RELIEF VALVE PASSED D FAILED E .L-l rsn OPENEO AT OPENED AT I I lo[-..]p5p DIO NOT OPEN D PRESS DROP lllol--1e56 LEAKED T + 1 PEESS OBOP I I i o[--le5a OPENED AT lll.Ll m PRESS DBOP I I l.!--lps IGHT tr TIGHT tr RELIEF OPEN lllo[-Jp5e -f/ BY:(REPRESENTANVE OR FIRM) STlHiS0fi - PLUi,t;t:!B &, f{EA.It,Tg, tt{C. 129s 0cEA, nErr EUGENE ORE;.< 97aTz (503) 687'13$I t)BB4 BACKFTOW PREVENTION DEVICE TEST REPOR.T FIRM NAME: DEVICE ADDBESS: DEVICE SIZE: DEVICE LOCA]ION: INMA[ 1ISr REPAIRS TESt ATTER RTPAIR STREET CITY ZIP r r r r/r',F,aLco , ,uooerflr(tSf.r r t r r r r DEVICE MAKE: SEHIAL NUMBER ,L,3,Q,6,/,t , , , , , INITIAL TEST -/ppssro E/ FAILED tr ,ond"t,E,'87 l5o I e70 AIl0,/0R PAfiTS OETECTOR METER READING IN COMPI-ETING AND SUBMJTIING THIS TEST REPOBT, THE TESTER CEFNFIES TH,AT THE DEVICE HAS BEEN IESTED AND MAINTAINED IN ACCORDANCE WlH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SYSTEM O\A/NER AND THE STAIE OF OREGON. SIGNATURE GAUGE #CEET * PBESSURE VACUUM BREAKER AIR INLET CHECK FEDUCED PRESSURE DEVICE DOUBLE CHECK VALVE LE,AKED D LeAKED fl PBE$S PRoPI ll.lQ ps6 ATT]GHT tr TIGHT tr CHECK #1 CHECK #1 CHECK #2 PStt) RELIEF VALVE PASSED FAILED D OPENED AT I I lrllp5a DID NOT opru D PRESS DROP I I lo[lp5p LEAKED ,1 PflESS DROP lllo[J25pTIGHT tr rcFfr tr REUEF OPEN I I lol--..lp5a OPENED AT I I l.L_.] ?s. PRESS DROP I I loljpso BY:ry K*l*^ (REPRESE NTATIVE OB FIBM} AFTER REPAIR DATE:I II,/I IIl,I II 0879sT!?istll PLUili.qi:le'-;ATi:iti, lllc 1299 OCtrfi Sil:EET EUGINE, 0iiliil i7,l02 (5!3) i'11l;';1 FIBM NAME: DEVICE ADDRESS: BACKFTOW PR,EVENTION DEVICE TEST REPORT ET DEVICE SIZE: DEVICE rrrrS hlAG, , ,*o,,,DEVICE MAKE: TL SERIAL NUMBER INMA[ TEST REPAIRS AND,/0R PAffTS Ttsr AFIER REPAIR INITIAL TEST ,ossto { FAILEO N oxc,tA,'tB,,8J AFTER REPAIR DATE:I I I?/l .l l,/l I I DETECTOR METER READING IN COMRETING AND SUBMITTING THIS IEST REPOBT, THE iESTER CERTIFIES THAT THE DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WAIER SYSTEM OWNEB AND THE STATE OF OREGON. SIGNAIURE bu'| B Ro GAUGE , CEtrT. (L.1.- PRESSURE VACUUM BREAKER AIR INLET CHECK DOUBLE CHECK VALVE LEAKED ELEAKED N TIGHT TIGHT PSIO CHECK # 1 CHECK #2 REDUCED I I lol-l psro OPENED AT DEVICE CHECK # 1 REUEF VALVE plsseo E rnrco E OPENED AT I I loL-.]psm DID NOT oprru D PRESS DROP I I rollpso LEAKED .1 PRESS DROP lllrl-lpssTIGHT D REUEF OPEN I I loL-lpso OPENED AT I i l.L-J pstr PAESS DROP r ..L-lrso TIGHT tr 8Y:(RE PRESlllrATrvE oB FrRM)