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HomeMy WebLinkAboutMiscellaneous Backflow Test 1986-4-24 B~CK:LOW PREV!N;I,ON DEVICE TEST AND MAINTENANCE REPORT p/ TO. ,L..., I L,!' <c ~-.1 / ./.....1 i~ , .--r;' A J :7 _.> ,. -<- - ---- -'V ~ ~~"~A'~b 'V / (j / We have made the following test, as required by the Oregon Administrative Rules 333-61-070 ADDRESS OF DEVICE d :Z:O ?;>~ a;~. ~~ "f,/- NEW -----i;;~TlNG LOCATION OF DEVICE ~N PROPERTy:<f?'> /I,...;:l, nu;/f; I ""'>:~".P /?~ /.... ___ ~~. TYPE OF DEVICF' '/t~- 76,S"' .1.'7 VR . . ;iii::: /' SERIAL NO.. 7c:lD 72-. . DEVICE SERVES OR ISOLATFC:: P/T/..RL? - ,-?R/I/,///l;vJ~t. THE ABOVE TEST HAS BEEN COMPLETED FIRM NAME: ?/~~. --!.-!~?!z;1,.-vkL- -~ /:f"r .::_, M ~~NR:TS~~.E 6~~vi~i6~~~~ ~i:;~~fj{~E: r--:J /J Dl _, j ~. ,.; 7~70100 . ~f/" ~~ .. .-- ,._----- CHECK NO.1 NO.1 Test Leaked P.S.1. Before Repairs Closed Differential .~.. Tight ( ) , , Test A Iter Closed P.S.1. Repairs Tight ( Differential New Materials and Repairs Made Remarks DIFFERENTIAL ~: PRES. RElIEF/' CHECK NO.2 VALVE i L/ NO.2 Opened at Ibs. Differential Leaked .' Closed Tight ( P.S.1. Differential ... .~.., l!t--___..._...;._._.., Opened at " Closed .lbs.'Tight ( Differential P.S.1. Differential Relief port has approved air-gap: Yes' No:,_ , i.#./ , ,.. .... ..;~ ..- Repaired By: Date PRESSURE TYPE VACUUM BREAKERS ~ Air Inlet Check Valve Opened ( Did Not Open ( ) Leaked Closed' Tight ( Opened ( Closed Tight ( Valve 12" above highest head Yes_ No_ Double Detector Check valve meter ,. Reading Pre Test After Test - After Flushing Tested BY:U~~"""~L.- Certification N6.:Lo~ 9' ? Date: f/-..?t//.:;; Pr:o ,/Ice, /t-P - 3~:J .3;z. C-{O :2.crO 6757 ". , , , .