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BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: \ , 2_0)L4 <br /> Owner Name: 6 IV Paul e <br /> Backwater Valve Address: 1603 @a? Jo4-QA f5kvc� <br /> The backwat valve installation is complete: <br /> Yes L3 No ❑ <br /> You have been shown where the backwater valve is, and the flapper assembly is currently in <br /> place and functional: <br /> Yes [ - No ❑ <br /> You were given instructions and training on how to maintain the backwater valve: <br /> Yes No ❑ <br /> You understand that you own the backwater valve and are responsible to maintain it in the <br /> future: <br /> Yes " No ❑ <br /> Signature , Date ��3 2a r <br /> / <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.docx <br />