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BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: -3 use - 241 I <br /> Owner Name: 1 iCAAn A YC Co 1v <br /> Backwater Valve Address: y ZQ 2. 1 y roc r. <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 functional: <br /> Yes Eir No ❑ <br /> You were given instructions and training on how to maintain the backwater valve: <br /> Yes a No ❑ <br /> You understand that you own the backwater valve and are responsible to maintain it in the <br /> future: <br /> Yes Er No ❑ <br /> Signature h/c� =----- Date , .),nc <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.dooc <br />