HomeMy WebLinkAboutPermit Backflow Test 1986-10-25
.
.
~
!() 6'~/
IV V.,J
SPRINGFIELD UTILITY BOARD
250 North "A" St.
Springfield, Oregon 97477
BACKFLOW DEVICE TEST REPORT
FIRM NAME:
fir! 4 ,y} ,;
~.."i
AODRFC'C" 3. <)-CY::.--
'. II
SIZE Jh MOOEL
/rI-';-, a'/, 9
Q,I') d.
t<.! 'l: if... . t",-:'J .
'..."'j SERIAL# ;.JY7J<-/
LOCATION OF DEVICE: 7J V u"i/I/~~,~ 1'Y,'el-~,.---
REDUCED PRESSURE DEVICES I PASSED:lC ...,J.S-8'c.
DOUBLE CHECK VALVES Pressure I
FAILED:
f-
'"
w
f-
.J
"
;::
Z
Check
#,
Check
#2
Drop Across
,J:heck
/~(.,
Leaked
Leaked
Closed
Tight I~
Closed
Tight 9<J
Relief
Valve
Opened at
3,0
New Parts
andfor
Repairs
Made
If Needed
Final Test
After
CJl.efk C~eik Relief
Closed Closed Valve
Tight Tight Opened at
( ) ( )
Repain
TESTER: /); '0':"
Ibs. ---: I LI:2. y
y<..i..,~ -""'''''
CERTIFICATION
#i--s,YG
Ibs.
DATE:
TESTER #
NAME:
lbS.1 DATE:
I CERTIFY THE ABOVE TEST HAS BEEN PERFORMED,
BY 'Jh1--#-~ {L<~~ ~
.
(COMPANY OFFICERI