HomeMy WebLinkAboutMiscellaneous Backflow Test 1987-4-22
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BACKfJ.QW PRlY'''iT10N PEYICE TEST REPORT '
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I REDUCED PRESSURE DEVICE PRESSURE VACUUM I
I INITIAL T<ST
I' I DOUBLE CHECK VALVE CHECK # 1 BREAKER PASSED .
I CHECK # 1 CHECK # 2 I I AIR INLET I CHECK I FAILED 0
~S OROP I
,"mAl I TIGHT 0 TIGHT 0 l,r~ ;.ifi.~T OPENED AT PRESS DROP i DAT<,L1J/~'~ I
, TIST l.S'J.i8"" Ll..J.u"" Ll..J.U"" I
H REUEF VALVE '
LEAKED 0 lEAKED 0
PASSED . DID NOT I
LEAKED I
FAILED 0 OPEN 0
.
~~
l$!;~
l(.. i' _~
FIRM
NAME:
DEVICE
ADDRESS,
REPAIRS I
ANO/1lI I
PARTS
I
I
,- 1 PRESS DROP ~
Ll..J. u... 1 OPENEO AT
TI~T 0 "
I REUEF OPEN I Ll..J'U ""
Ll..J. u... I
TIST
AFTIR
REPAIR
TIGHT 0
.~
" .
I AFTER REPAIR
PRESS DROP DAT<'Ll..J/Ll..J/Ll..J
LLJ.UPSII '
I
DeTECTOR METER READING
IN COMPlETING AND SUBMITTING THIS TEST REPORT. THE TESTER CERTIFIES lliAT THE
DEVICE HAS BEEN TEmD AND MAINTAINED IN ACCORDANCE WITH All APPLICABLE
RULES AND REGULATIONS OF mE V\lA.TER SYSTEM OWNER AND THE STATE OF OREGON.
~mT<~
/10
GAUGE.
d.J SIC:;
CEAT. t-
BY:
"~ ~:'.....o (REPRESENTATIVE OR FIRM}
I CERTIFY THE ABOVE TEST HAS BEEN PERFORMED
WATER SYSTEMS COPY