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t 17AACRA Backflow Testing and Repair, Inc BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br />s3C-:� '--t (360)668.1117 <br />WATER PURVEYOR FA ci ctl <br />ASSEMBLY ID/FILE #/UTILIT Y DEVICE # <br />NAME OFPRF.MISF. 2631 Walnut <br />SERVICE ADDRESS 2631 Walnut St. <br />CONTACT PE <br />LOCATION OF ASSEMBLY Left Wall just after entering, back I'00n) <br />Meter # <br />Commercial LW Residential [ <br />Everett 'ZIP 98201 <br />PHONE <br />DOWNSTREAM PROCESS Premise Isolation DCVA ❑ RPBA 0 PVBA ❑ OTHER <br />NEW INSTALL [, EXISTING I_.' REPLACEMENT J REMOVED OLDSER.# <br />APPROVED ASSEMBLY? YES RI NO ❑ PROPER INSTALLATION? YES W NO ❑ <br />MAKEOFASSEMBLY Conbraco/Apollo MODEL RPLFIA SERIAL NO. 050660 SIZE 151 <br />DCVA/RPBA <br />DCVA/RPBA <br />RPBA <br />PVRA/SVBA <br />INITIAL <br />CHECK VALVE. NOA <br />CHECK VALVE N0.2 <br />AIR INLET <br />TEST <br />OPENeDAr j'SID <br />CLOSED TIGHT ❑ <br />CLOSED TIGH"I❑ <br />_,.2 <br />OPENED AT PSID <br />PASSED <br />91 CHECK 3.4 PSID <br />❑ <br />LEAKED ❑ <br />LEAKEDEl <br />DID NOT OPEN <br />FAILED r <br />PSID <br />PSID <br />AIR GAP OK? YCS <br />CLEAN REPLACE PART <br />CLEAN REPLACE PART <br />CLEAN REPLACE PART <br />CHECK VALVE <br />NEW <br />� ❑ � <br />❑ 1—' <br />❑ 7: --- <br />HELD AT PSiD <br />PARTS <br />_ <br />❑ ❑ <br />_ <br />i <br />LLXKED ❑ <br />❑ ❑ <br />n D <br />D ❑ <br />AND <br />❑ ❑ <br />D ❑ <br />D ❑ <br />(AT INI.D ❑ <br />REPAIRS <br />R1 PAIRED ❑ <br />1FT'F.R <br />rW <br />CLOSEDTIGH'L :.�; <br />CLOSEllT'IGHT G <br />RVEXERClSFU �J <br />(IRIS'LEr PSIU <br />PAIRS <br />LEAKED L <br />LEAKED C <br />OPENED.AT 2.7 PSID <br />--- <br />PASSED IV—] <br />PSID <br />PSIU <br />of cn):cK 7.8 PSID <br />CHK VALVE PSID <br />FAILED ❑ <br />AIR GAP INSPECTION: SUPPLY PIPE. DIAMETER _ SEPARATION PASS[) FAILD <br />DETECTOR METER READING <br />LEFT SERN ICE AS FOUND Isolation valve: Open u Closed D SOVNI Open u Closed ❑ SOV42: Open k7 Closed ❑ <br />REMARKS: <br />— LINE PRESSURE 51 PSI CONFINED SPACE? No <br />TESTERS SIGNATURE: ArAtiftw CERT. NO. B5601 DATE. 312612015 <br />TESTERS NAME PRINTED Gary L. Bross'n TESTERS PHONE 4 (360)668-1117 <br />REPAIRED BY: Gary L. Brown LIC NO. BROWNGL909Q DAI'F 03-26-2015 <br />FINAL TEST BY: Gary L. Brown CERT. NO. B5601 DATE 03-26-2015 <br />CILIRRATION DATE I1.25-2014 GAUGE;' 03050953 MODEL Midwest 845 SERVICE RESTORED YFS [. NO 7 <br />I certi(v that this report is accurate, Anil I have used IVAC 246-2911490 approved test methods and test equipment. /�� <br />