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0 i <br /> BATMASTER BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br /> (425)397-0275 <br /> WATER PURVEYOR Everett ACCOUNT# <br /> ASSEMBLY ID/FILE#/UTILITY DEVICE# Meter# <br /> NAME OF PREMISE Fluke Building Commercial El Residential ❑ <br /> SERVICE ADDRESS 6920 Seaway Blvd. Everett Zip 98203 <br /> CONTACT PERSON Dan Cronenwett PHONE (425)348-1789 <br /> LOCATION OF ASSEMBLY VLT NXT TO HYDRNT SW CRNR OF NT OF MERRILL CRK PKWY/SEAWAY B <br /> DOWNSTREAM PROCESS Bypass-Fire Sprinkler System DCVA O RPBA ❑ PVBA ❑ OTHER <br /> NEW INSTALL U EXISTING ❑ REPLACEMENT El REMOVED LI OLD SER.# <br /> APPROVED ASSEMBLY? YES W NO❑ PROPER INSTALLATION?YES lJ NO ❑ <br /> MAKE OF ASSEMBLY Watts MODEL 007M20T SERIAL NO. 21591 SIZE •75" <br /> INITIAL DCVA/RPBA PCVA/RPBA RPBA PVBA/SVBA <br /> TEST CHECK VALVE NO.1 CHECK VALVE NO.2 PSID AIR INLET <br /> OPENED AT <br /> CLOSED TIGHT ll CLOSED TIGHT W OPENED AT PSID <br /> PASSED [] LEAKED ❑ LEAKED ❑ #1 CHECK PSID <br /> FAILED ❑ 2.2 PSID 2.4 PSID <br /> AIR GAP OK? DID NOT OPEN Li <br /> CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br /> NEW ❑ ❑ ❑ ❑ E7 ❑ HELD AT PSID <br /> PARTS ❑ ❑ ❑ El ❑ ❑ LEAKED [_] <br /> AND ❑ 11 El E7 ❑ <br /> ❑ ❑ ❑ ❑ EE El CLEANED H <br /> REPAIRS REPAIRED ❑ <br /> TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT El RV EXERCISED ❑ AIR INLET PSID <br /> REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT <br /> PSID <br /> PASSED ❑ <br /> FAILED ❑ PSID PSID #1 CHECK PSID CIS VALVE PSID <br /> AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASS El FAIL El <br /> DETECTOR METER READING <br /> LEFT SERVICE AS FOUND Isolation valve: Open [] Closed ❑ SOV#1 Open El Closed [] SOV#2: Open ❑ Closed [] <br /> REMARKS: <br /> LINE PRESSURE 94 PSI CONFINED SPACE? No <br /> TESTERS SIGNATURE: . sletvs-- f--- CERT.NO. B4594 DATE6/30/2016 <br /> TESTERS NAME PRINTED Thomas C.Gamman TESTERS PHONE# (425)397-0275 <br /> REPAIRED BY: LIC NO. DATE <br /> FINAL TEST BY: CERT. NO. DATE <br /> CALIBRATION DATE 10-29-2015 GAUGE# 01100930 MODEL Midwest 845 SERVICE RESTORED YES C1 NO [ <br /> I certify that this report is accurate,and I have used WAC 246-290-490 approved test methods and test equipment. <br />