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AACRA Backllow Testing and Repair, Inc. BACI(FLOW PREVENTION ASSEMBLY TEST REPORT <br />(360) 668.1117 <br />WATER PURVEYOR Everett <br />ASSEMBLY ID/FILE N/UTILITY DEVICE N Meter N <br />NAME OF PREMISE 2631 Walnut St. Commercial RJ Residential L <br />SERVICE. ADDRESS 2631 Walnut St. Everett ZIP 98201 <br />CONTACTPE <br />PHONE <br />LOCATION OF ASSENIRLY Fuck Room on Rt. Wall IDSt before entering freezer <br />DOWNSTREAM PROCESS ice ,\Iaker DCVA ❑ RPRA W PVBA ❑ OTHER <br />NEW INSTALL © EXISTING U RF.PLACFMENr REMOVED El OLDSER.N <br />APPROVED ASSEN11FL1'? YES v NO ❑ PROPER INSTALLATION:' YES [%De NO ❑ <br />NIAKE OF ASSEMBI-N Conhraco/ADoIID MODEL ItPI F 1:\ SI. RIAL NO. 651913 SIZE •� <br />DCVA I RPRA <br />DCVA, RPBA <br />RPRA <br />PVHA / SVIIA <br />INITIAL <br />CHECK VALVE <br />NO.] <br />CHECK VALVF NO.? <br />,AIR INLET <br />TEST <br />OPENEDAI 2.6 'Sit) <br />CLOSFUTIGHT <br />i_ <br />CLOSF.D'FIGHi _ <br />OPENLUAI <br />PSID <br />PASSED <br />r.l CHECK 3.8 'Sit) <br />LEAKED <br />C' <br />LEAKED �.� <br />DID NO TOPEN <br />L <br />FAILED <br />C <br />PSID <br />PSID <br />AIR GAP OK". YeS <br />CLEAN nE°L'C' <br />PART <br />CLEAN REPLACE PART <br />CLEAN REPLACE PART <br />CHECKVAL'L <br />NF,W <br />;,1 ❑ <� <br />❑ ❑ <br />❑ ❑ <br />HF:LD:AT <br />PSID <br />PARTS <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />LF.AKF.D <br />L- <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />AND <br />El Li <br />El❑ <br />❑ U <br />CLEANED <br />[-' <br />REPAIRS <br />REPAIRED <br />L] <br />)F.ST AFTER <br />CLOSF.DTIGHT <br />CLOSEDTIGHT EV, <br />RV EXERCISFD ❑ <br />:AIR INLET <br />PSt]) <br />REPAIRS <br />LEAKED <br />❑ <br />LEAKED 1=' <br />opLNEu AT ''.G PSID <br />- <br />PASSED <br />u <br />PSID <br />PSID <br />+'I CIIF.CK 5.4 PSID <br />CIIK VALVE <br />PSID <br />FAILED <br />❑ <br />AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASSE) FAIL❑ <br />DETECTOR METER READING <br />LEFT SERVICE AS FOUND Isolation vnlve: Open ❑Q Closed ❑ SOVNI Open ❑Q Closed ❑ SOV92: Open ❑ Closed � <br />REMARKS: <br />LINE PRESSURE 42 PSI CONFINED SPACE? No <br />TESTERS SIGNATURE: 49orlawkw CERT. NO. B5601 DATE 312612015 <br />TESTERS NAME PRINTIiU Gard L. Brms'D TESTERS PHONE N �360�668-1117-1117 <br />REPAIRED IIY: Gary L. Brown LIC NO. BROWNGL909Q DATE <br />FINAL TEST BY: Gary L. Brown CERT, NO. B5601 DATE <br />CALIRRATION DATE. 11-25-2014 GAUGE N 03050953 MODEL Midwest 845 SERVICE RESTORED YES ❑ NO OV <br />I certify that this report is accurate, and I have used WAC 246-290490 approved test methods and test equipment Z/ <br />