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BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: 1 , 20 t <br /> Owner Name: \AA;t 1II YVVAirOn.tA <br /> Backwater Valve Address: LP 1 S t.Oc.nre ov&. <br /> The backwater valve installation is complete: <br /> Yes Er No ❑ <br /> You have been shown where the backwater valve is, and the flapper assembly is currently in <br /> place and functional: <br /> Yes g No ❑ <br /> You were given instructions and training on how to maintain the backwater valve: <br /> Yes FIT No ❑ <br /> You understand that you own the backwater valve and are responsible to maintain it in the <br /> future: <br /> Yes Et No ❑ <br /> Signature.-/ .,.2%4�4.Rx \w\t Yi'T Date 2,€ ' `1 1 Li <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.docx <br />