HomeMy WebLinkAboutMiscellaneous Field Test & Inspection Report 2008-8-22
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BACKFLOW ASSEMBLY TEST REPORT
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. PRESS DROP . ~ ~ (All CHECK #1 INLET
INITIAL REL.IEF VALVE < ~J ....
TEST OPENED" AT ~,~ j .4-"(BlITIGHT ID_ OPENED AT: PRESS DROP
RE MIN]. I'SlIJ ILEAKED 0 PSID
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SYSTEM
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COMMENTS
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PRESS DROP (A) IVm"~P..(>v,\a~,..,;<~
ICHECK #1
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A-B~ J
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IN COMPLETING AND SUBMrmNG nus TEST REPORT. lliE TESTER CERTIFIES Th .T ThE
ASSEMBLY HAS BEEN TESTED AND MAfNTAJNED IN ACCORDANCE wmi ALL APPLICABLE
/'-----:\ /__RUCES-AND~GULATIONS OF ruE WATER SYSTEM. AND STATE REGULATIONS.
GAUGE l~lIl~TI?..!:I--OATE :e../ .8 /8 DETECTOR METER READlNGC_183Z
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JOHN PRIE3T btl~-~
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TEST
AFTER
REPAIRS
TE.sTERS NAME PRINTED
TESTERS ADDRESS
COMPANY NAME
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REPORT RECEIVED BY.
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PASSED 0
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PHONE"
(REPRESEl<f'ATIVE OF OWNER)
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PINK. Cuslorncr Copy
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OPENED (8) j!IGHT O. . PSID . -,.;t / /
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A-B- 0
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./....-A--_RULES..ANQ.... REGULATIONS OF niE W".~q, SYSTEM. AND STATE REGULATIONS.
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PRESS DROP (CHECK #1-oT-. ' . DATE:
RELIEF I I \ ~ OPENEO_AT' PRESS DROP
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BUFFER CH"EGK-#2"
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IN COMPLEmNG AND SUBMrrnNG 11-IlS TEST REPOttT. mE TESTER CERTIfIES TI-lAT niE
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TESTER/ SIGNATURE JOHN
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324 WICKHAM CT.
leSTERS ADDRESS I ~A!i~lOW SPECIAlTIES
COMP,,",Y N~M,' ; I,:;:j!: i /"1' lillf\.
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REPORT RECEIVED BY;
TEST
AFTER
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TESTF.:RS NAME PRINTED
C-1832
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6~6b20
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(REPRESENTATIVE OF OWNER)
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~El-SERVICE RESTORED
WHITE - Wiler Sy~lem Copy
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M.N 2 PSlD !LEAKED 0 PSIO
RESULTS BUFFER
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DATE:
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IN COMPLETING AND SUBMrrnNG nus TEST RI::PO~T. llIE TESTER CERTIFIES TIiAT T1iE
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GAUGE CALlBRATH)J'~-"DATE / 5 /e DETECTOR METER READING
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REPORT RECEIVED BY, (REPRESENTATIVE OF OWNER)
C-1832
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PHONE /I
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WHITE - Wiler Sy~cm Copy
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YEl.LOW. Tester Copy
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PNWS-AWWA BACKFLOW ASSEMBLY TEST REPORT OREMOVED
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PROPERTY
OWNER: ~ Ct. -e-<<.J Uk.t :PHONE:
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IN COMPLETING AND SUBMrrnNG TIllS TEST RJ::PORT, ~E TESTER CERTIFIES mAT l1-IE
ASSEMBLY HAS IlEEN TESTED AND MAl1'rrAINED IN A.CCORDANCE Wm-l AU. APPLlCAIlLE
/7 _ ~ULES A:D REGUL.A2/NS ~/ll~ WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIBRATION DATE <= "'" DETECTOR METER'READlNG
h~<'~---
~------
TESTER'SIGNAlURE
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COMMENTS
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JOHN PRIEST
324 ,WICKHAM CT.
!iAl,;KFLOW SPtCIALTltS
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COMPANY NAME I
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REPORT RECEIVED B!i -
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o AIR GAP
'INITIAL TEST
PASSED~Q;'
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DATE:
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DATE:
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:~~~iBLY HAS BEEN TESTED AND MArNTAINED IN ACCORDANCE wml ALL APPLICAIlLE
/.....J .-,4'-~ REGUL.ATI~S o..F TIlE WATER SYSTEM. AND STATE REGULATIONS
GAUGE .~~:!!:..~~ 1 8 / e DETECTOR METER READING
TESTER SIGNATURE
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AfTER
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~
AfTER REPAIRS
DATE:
TESTERS NAME PRINTED
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WHITE. Water Syslc:m Copy
PINK. Cuslomer Copy
YELLOW. Tater Copy