HomeMy WebLinkAboutPermit Backflow Test 1987-11-9
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BACKFLOW PREVENTION DEVICE TEST REPORT
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DEVICE . , . SERIAL / C; C/ /. J
lOCATIOl<.C, . -....; '"" 'H r il " 0) ',' NUMBER I .... 11 ( I." I u It I I , I ,
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I flEDUCED PRESSURE DEVICi! II' PRESSUnE VACUUM
I.. H\lIT1AL TEST
DOUBLE CHECK VALVE I CHECK' 1 I' BREAKER PASSED Er-""
I CHECK If 1 CHECK #2 ~ AIR H~LET CHECK FAILED 0
PR~S 9ROP I
: I LJLi.r'(, ,.", I OPENED AT ,'nESS DROP DATE.,..'tli/uZiil,tJ7
INITIAL : TIGHT 0 lIGHT 0 RHIlf OPu,'J,D AT "-
TEST Lbl!.~ l':;:o ~.Uf'Sil. LLJ.UI'SII
REUEF VALVE I
LEAKED 0 lEAKED 0 PASSED B"'" DID NOT
FAILED 0 OPEN 0
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LEAKED
NOV
n 1987
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REPAIRS
AND/OR I
PARTS '
l1ST
AFTER
REPAIR
. 1 PRESS DROP !
TImWlhT =DHCIIt{ b'I}<\U"" ! OPENED AT PRESS DROP
m -~ "LI' fl\L~OPEN I
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AFTER REPAIR
DATE.U.J/u,JlLU
DETECTOR METER READING
IN COMPLETING AND SU8MlTTlNG THIS TfST REPORT. THE TI;STER CERTIFIES THAT THE
DEVICE HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE 'vvATHt SYSTEM OV'INER AND THE STATE OF OREGON.
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TESTERS SIGNATURE
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GAUGE .
A-/79
CERT ..
BY;
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( 1.!-(;1":\..-~~1.. j .. ,. .. !REP~ESENTAT'VE OR F1RMI
'-.-/.. 1 CEilT:FY ~Af;nVE TEST H.\S C[[i'J ?ErlrORMED
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