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ABC Water Specialty Inc. <br />Christine Purdy <br />State Certified BAT <br />Specialty Plumbers License <br />Phone: 425-355-9826 <br />Serving Snohomish. Nam Krrj. 51apn C.Mn n <br />Dgo s= 6/3 <br />NAME OF PREMISE Schmidt Medical Building WATER PURVEYOR. EVERETT WATER <br />SERVICE ADDRESS 4418 Rucker Avenue Everett <br />CONTACT PERSON. Mark Phone: 425-754-5423 Wrk Cell <br />OWNER / PM. Fowler Mechanical Contact Person <br />MAILING ADDRESS: 2324 -11Oth Drive SE Everett 98205 PHONE 253-531-6003 Julie FAX <br />LOCATION OF ASSEMBLY: <br />::I, 1rS <br />NO OF ASSEMBLIES THIS LOCATION _COMMERCIAL IJ RESIDENIIAL " EXISTING LJ NEWLAJ REPLACEMENT LJ <br />ASSEMBLY Manufacturer C OM blIAC C) Model qo Z.O 7 L F,ze I 2� Serial ((3 4 1 <br />DOWNSTREAM USAGE DOMESTIC LINE PRESSURE AT TIME OF TEST Ys PSI <br />DATE: November 13, 2008 <br />INITIAL TEST RESULTS <br />No. 1 Check Valve <br />DCVA <br />Differential <br />PSID Leaked EJ <br />No.2 Check Valve: <br />Differential <br />PSID Leaked <br />Passed Test Yes <br />No <br />Apparent Pressure Across No 1 Check Valve r <br />Relief Valve Opened <br />PSID <br />No.2 Check Valve: <br />RPBA <br />Closed Tight <br />Leaked <br />No. 1 Check Valve: <br />Closed Tight <br />aked <br />Static Pressure Drop Across <br />Check Valve # 1_1_ <br />PSID <br />r, <br />Minimum A/G present Yes IJ No <br />Passed Test Yesm <br />No <br />Air Inlet: Failed to Open <br />Opened PSID <br />SVBA <br />Continued to Open Fully. <br />YesE::]No <br />PVBA <br />Check Valve: <br />Differential <br />PSID Leaked <br />Passed Test Yes <br />No <br />E <br />No <br />DATE: TEST AFTER REPAIRICLEANING <br />No. 1 Check Valve <br />Differential PSID Leaked <br />No Check Valve: <br />Differential PSID Leaked <br />Passed Test Yes No <br />Apparent Pressure Across No. 1 Check Valve <br />Relief Valve Opened 2,9 PSID <br />No.2 Check Valve: <br />Closed Tight ® Leaked <br />No. 1 Check Valve: <br />Closed Tight © Leaked ED <br />Static Pressure Drop Acr <br />` <br />Check Valve #1PSID <br />` <br />r�� <br />Minimum AIG present Yes 1 /C INo <br />Passed Test Yes14 No Y� <br />Air Inlet: Failed to Open <br />Opened PSID <br />Continued to Open Fully: Yes =No O <br />Check Valve: <br />Differential PSID Leaked <br />Passed Test Yes No <br />PROPER INSTALLATION: YES�DNO F--j WASHINGTON STATE APPROVED ASSY: YESEKINO = <br />Approved In DOH Pub 0 331.137 (Rev. 5107) <br />Remarks: After testing completed; returned SOV's to the original position [prior to testing] <br />Repairs: c(QCe,lli?— *"' ) G V <br />I CERTIFY THE ABOVE REPORT TO BE TRUE: <br />Certified Tesler William Pur¢v <br />Test By. <br />REPORT SENT TO <br />TEST EQUIPMENT: MID -WEFT 830 SN# 06020544 <br />CALIBRATION DATE: June 10. 2008 CERT NO. B4063 <br />Test Date: November 13, 2008 <br />COPY LEFT ON SITE <br />