HomeMy WebLinkAboutMiscellaneous Backflow Test 1986-4-24
B~CK:LOW PREV!N;I,ON DEVICE TEST AND MAINTENANCE REPORT p/
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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
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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
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3~:J .3;z. C-{O :2.crO
6757
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