305 SE EVERETT MALL WAY SIGNARAMA 2020-03-06

AACRA Backflow Testing and Repair,Inc. BACKFLOW PREVENTIOIISSEMBLY 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 Cl 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 Bypass DCVA 0 RPBA ❑ PVBA ❑ OTHER NEW INSTALL ❑ EXISTING 0 REPLACEMENT ❑ REMOVED Cl OLD SER.# APPROVED ASSEMBLY? YES 0 NO ❑ PROPER INSTALLATION?YES 0 NO ❑ MAKE OF ASSEMBLY Watts MODEL 007M2OTSERIAL NO. 213479 SIZE •75" INITIAL DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT PSID CLOSED TIGHT 0 CLOSED TIGHT 0 OPENED AT PSID PASSED LEAKED ❑ LEAKED ❑ #1 CHECK PSID FAILED ❑ 2.0 PSID 2.3 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 CJ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRS REPAIRED ❑ TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID PASSED El 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 Closed ❑ SOV#2: Open W Closed ❑ REMARKS: LINE PRESSURE 90 PSI CONFINED SPACE? No TESTERS SIGNATURE: CERT.NO, 66423 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 0 NO ❑ I certify that this report is accurate,and I have used WAC 246-290490 approved test methods and test equipment.