HomeMy WebLinkAboutPermit Backflow Test 1987-11-10
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BACKFLOW PREVENTION DEVICE TEST REPORT 0 REPLACEMENT
FIRM
NAME:
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DEVICE
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TiGHT ~.m. RELIEF QPENm AT
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: ' REUl:F VAt VE'
LEAKED 0 LEAKED 0 .
I PRESS DHOP PASSED 0
REPAIRS i LJ~.U"~ FAILED 0 1
AND/OR! .. r
PARTS
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TEST
AFTER ,TIGHT
REPAIR
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TIGHT 0
1., PR'SS DROP II ~YJ H tH El~mW~REPAIR .
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I RELIEF OPEN I I
LLJ-U.,., UJ.U"" I
l_LJ. LJ1'S(I II
DETECTOR MHER READING
IN CQNPLETlNG AND SUBMITIING THIS TEST RtPORT, THE TESTERCEATIFIES THAT THE
UEVICE HAS BEEN TESTED AND MAINTAlr!ED I!>l Aa.:OROANCE 'NlTH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER $Y$lErJ ~\NER AND THE STAlE OF OREGON.
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(RE?RESFNTAT!VE OR FIRMI