305 SE EVERETT MALL WAY SIGNARAMA 2020-03-06

AACRA Backflow Testing and Repair,Inc. BACKFLOW PREVENTIOISSEMBLY TEST REPORT (360)668-1117 WATER PURVEYOR Everett ACCOUNT# ASSEMBLY ID/FILE#/UTILITY DEVICE# Meter# NAME OF PREMISE Green Tree Plaza 06 A LLC Commercial ❑ Residential ❑ SERVICE ADDRESS 305 SE Everett Mall Way Everett ZIP 98203 CONTACT PERSON Richard Taylor PHONE (425)280-8116 LOCATION OF ASSEMBLY Vault in front of Sally Beauty Supply DOWNSTREAM PROCESS Fire Service DCVA r❑ RPBA ❑ PVBA ❑ OTHER NEW INSTALL ❑ EXISTING W REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES ❑O NO ❑ PROPER INSTALLATION?YES 10 NO ❑ MAKE OF ASSEMBLY Watts MODELSERIAL NO. B 1813 SIZE 8" INITIAL DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT PSID CLOSED TIGHT W CLOSED TIGHT E OPENED AT PSID PASSED LEAKED ❑ LEAKED ❑ #1 CHECK PSID FAILED ❑ 2.6 PSID 3.2 PSID AIR GAP OK? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑ AND ❑ ❑ ❑ El ❑ ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRS REPAIRED ❑ TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID PASSED ❑ FAILED ❑ PSID PSID #1 CHECK PSID CHK VALVE PSID AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASS❑ FAIL❑ DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open d❑ Closed ❑ SOV#1: Open ❑d Closed ❑ SOV#2: Open 0 Closed ❑ REMARKS: LINE PRESSURE 90 PSI CONFINED SPACE? No TESTERS SIGNATURE: CERT.NO. B6423 DATE 5/20/2019 TESTERS NAME PRINTED Joshua Cobb TESTERS PHONE# (360)631-0039 REPAIRED BY: LIC NO. DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE 12-04-2018 GAUGE# 12180097 MODEL Midwest 845- SERVICE RESTORED YES W NO ❑ I certify that this report is accurate,and I have used WAC 246-290-490 approved test methods and test equipment.