HomeMy WebLinkAboutMiscellaneous Backflow Test 2010-5-12
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PNWS'AWWA BACKFLOW ASSEMBLY TEST REPORT DREMOVED
PROPERTY I( C . 0 REPLACEMENT
OWNER: , ! n 057.,;.' ST ( wet, '-"" PHONE: LidS - ;;; L -' .>-
MAILING .1\ ,J j / I
ADDRESS: rJ ,:/.)(1) 1~IDf;I"'I()Vc.. f vt'.
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ASSEMBL~ rJ --/7- * I -..,1
ADDRESS: rJ T '-'. ' ~ sT' - It( L ~
STREET
OR.P.B.A.:r:;i D.C.V.A. 0 R.P.D.A. OD.C.D.A. OP.V.B.A.
SIZE: L.1l.J,fLJrz,1 MAKE: W, lie"",
WATER
PURVEYOR: ...:::, U D
ASSEMBLY v . 1- . J r
LOCATION: 1'--'/,111 5/0,,- f.)-t-
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STATE 0\2. ZIPC)'7'-/iDr<
S-;:"'/lAf (-' 0. (512'-1 "IlS
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o S.V.B.A. 0 A.V.B. 0 AIR GAP
MODEL:
, ,
,
SERIAL
NUMBER:
J1v/Jse.
~/(-,d :st.i.
REDUCED PRESSURE ASSEMBLY P,V.B.A. I S.V.BA IN ITIAL TEST
'1 CHECK ,'DP1Jl!lLE'CHECK AIR CHECK PASSED 1ef
PRESS DROP (All C,!OCK #1 INLET FAILED '0-
INITIAL RELIEF VALVE (B)ITIGHT :Ej:1. '/ OPENED AT; PRESS DROP
TEST OPENED AT DATE:
MIN2PSIO ILEAKED 0 PSlD .::./12 j/(J)
RESULTS BUFFER ~ ~
A-B = I CHECK #2
MIN l PSI 061.9
ITIGHT DID NOT FAILED SYSTEM !
RELI EF VALVE '- OPEN 0 0 PSI /
ILEAKEDO ""D
PASS 0 FAIL 0 , .
COMMENTS
REPAIRS
ANDIOR
PARTS
REDUCED PRESSURE ASSEMBLY P.V.B.A.lS.V,B.A. AFTER REP AI RS
'(CHECK
PRESS DROP .. (A) CHECK #1 DATE:
TEST
.RELlEF (') I TIGHT 0 - OPENED AT PRESS DROP / /
AfTER OPENED PSID
REPAIRS -.- f CHECK #2
BUI''''R PASSED 0
A+ BoO TIGHT 0 PSIO
_.~ PSID PSIO
IN COMPLET1NG AND SUBMfT11NG 1lI1S TEST RI::PORT, llIE TESTER CERTIFIES THAT 11iE
ASSEMBLY HAS BEEN TESTED AND MArwrAlNED IN ACCORDANCE wmt ALL APPLICABLE
RULES AND REGULATIONS OF 1lIE WATER SVSTEM, AND STATE REGULATIONS.
GAUGE CAI;IBRATION DATE:,) / ;'~j(/.) DETECTOR METER READING
_J\r./1~ 111_ ~/,:.J...y..... 453{
TESTER SIGNAnJRE \ . I I I .Il . CERn
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TE:ITERS "^ME PRI>r1'ED( " ." ,I ,>/ /\;., C' " a G^,JGE .
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TE:ITERS ^OORESS "~ ) -;;1 _ (/' .r' PHONEO
tl. ,11i..vlC e. 1.."." Ie (^"', -'::>f'r';,Cf'J
COMPANY NAME JJ / J/.
REPORT RECEIVED BV
(REPRESENTATIVE OF OWNER)
^d SERVICE RESTORED
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WHITE - Watc:J System Copy
PINK-C~Copy
YELLOW. Tester Copy