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BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: 7Ume_. 30 , 2O IL( <br /> Owner Name: itkturck E4t'a..rct s — 9i y P,ro€mil j Se.vv,c 2 S r r- <br /> Backwater Valve Address: to 3 \ Lri vv\b t C\ 4 v,2._ <br /> The backwater valve installation is complete: <br /> Yes L( No ❑ <br /> You have been shown where the backwater valve is, and the flapper assembly is currently in <br /> place and f ctional: <br /> Yes D No ❑ <br /> You were ' n instructions and training on how to maintain the backwater valve: <br /> Yes No ❑ <br /> You understa that you own the backwater valve and are responsible to maintain it in the <br /> future: <br /> Yes No ❑ <br /> Signature Date 0. 30' )5 <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.docx <br />