1710 W MARINE VIEW DR SOUND 2 SUMMIT 2023-10-23

BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT# _ NAME OF PREMISE f) 0 ) n CI ;2 U rY) M & �rA 'S Q6 UJ Commercial Residential ❑ SERVICE ADDRESS 1 ] 0 Lip , HAD f)tVi ftv _D('iye- CITY E VltCtft ZIP CONTACT PERSONErI C Yrn Mir- t Cj PHONE &09 0) 3Z _ L.6 1,5 FAX( ) LOCATION OF ASSEMBLY 1 1 DOWNSTREAM PROCESS 2)a n Nt k Z-t-r- DCVA ❑ RPBAI& PVBA ❑ OTHER NEW INSTALL M EXISTING ❑ REPLACEMENT ❑OgLD SER. # PROPER INSTALLATION? YES �NO El MAKE OF ASSEMBLY P�J MODELL M I KT SERIAL NO. 5r1 I B Q3 SIZE 110- " DCVA / RPBA DCVA / RPBA RPBA PVBA/SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED ATl) • O PSI CLOSED TIGHT OPENED AT PSID LEAKED ❑ LEAKED ❑ #1 CHECK - PSID PASSED 121, PSID AIR GAP OK? u DID NOT OPEN ❑ FAILED ❑ _PSID CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ ❑ ® LEAKED ❑ AND REPAIRS ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ ❑ ❑ ❑ ❑ ❑ ❑ - REPAIRED ❑ TEST AFTER CLOSED TIGHT Q REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID AIR INLET PSID PASSED ❑ PSID PSID #1 CHECK PSID CHK VALVE PSID FAILED ❑ _ AIR GAP INSPECTION: Required minimum air gap separation provided? Yes ❑ No ❑ Detector deter Reading REMARKS: TESTERS SIGNATURE: TESTERS NAME PRINTED: RachVFICIOCi io REPAIRED BY: FINAL TEST BY: UNT PRESSURE 55 PSI r� CONFINED SPACE? Q_ CERT. NO. 1 15 DATE ja� 0-3 TESTERS PHONE # ( ) q�j - 5q 3 " DATE 045 CRT. NO. DATE 11� .LIBRATION DATE a / _)(�oZGAUGE # [[aCCatb MODEL�5- 5 SERVICE RESTORED? YES NO ❑ I certify that this report is accurate, and I have used TTAC 246-290490 approved test methods and test equipment.