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9: 30 fir^ <br /> 47-7- <br /> BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: Mai 2 O , 20 i 4 <br /> Owner Name: ( \ arc eLanrel. <br /> Backwater Valve Address: CDO' 06-itre-v.. A d� <br /> The backwater valve installation is complete: <br /> Yes [ .' No ❑ <br /> You have been shown where the backwater valve is, and the flapper assembly is currently in <br /> place and functional: <br /> Yes Q' No ❑ <br /> You were given instructions and training on how to maintain the backwater valve: <br /> Yes [r 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 7_ 7,,t1 ell Date v eo ' f <br /> s:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.dccx <br />