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

BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT # NAME OF PREMISE C) b u n` 02 LJ Urn M 7 � i � \'l oc eL m Comercial ResidentialEl SERVICE ADDRESS 'DO LJ O , I- & f i nR �/ w _Dnyej CITY -Bl r tft ZIP gl b a Q' CONTACT PERSON 0- '(Y 1 f- PHONE Lr )3.25�-(, 73 FAXLOCATION OF ASSEMBLY 1 r h� (�p 60l CA I DOtii�TSTREAM PROCESS _J_ CQ 1e)a e 1 e DCVA ❑ RPBA)S� PVBA ❑ OTHER NEW INSTALL, EXISTING ❑ REPLACEMENT ❑ OLD SER. # _ PROPER INSTALLATION? YES)�irNO ❑ MAKE OF ASSEMBLY L.) �-S MODEL EFJO SERIAL NO. 31 as e) �) SIZE '/ a ' � DCVA / RPBA DCVA / RPBA RPBA PVBA/SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AEI Cs PSI CLOSED TIGHT . OPENED AT_ LEAKED ❑ LEAKED ❑ #1 CHECK _2_._ Q__PSID _PSID PASSED,. DID NOT OPEN ❑ FAILED ❑ Q y ' _ PSID PSID AIR GAP OK? ` CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ® ❑ HELD AT PSID PARTS ❑ ❑ ❑ ❑ ❑ D LEAKED ❑ AND REPAIRS ® ❑ ❑ ❑ - ❑ ❑ CLEANED ❑ ❑ ❑ ❑ ❑ ® ❑ REPAIRED ❑ TEST AFTER CLOSED TIGHT REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID AIR INLET PSID PASSED ❑ PSID PSID #I CHECK_ PSID CHK VALVE PSID FAILED ❑ AIR GAP INSPECTION: Required minimum air gap separation provided? Yes)k NO ❑ Detector deter Reading REMARKS: TESTERS SIGNATURE: TESTERS NAME PRINTED: Rach REPAIRED BY: FINAL TEST BY: LINE PRESSURE 55 PSI CONFINED SPACE? KJ() CERT. NO. DATE 5 FinochIO TESTERS PHONE # ( ) 3LQ 0' 59 3- DATE CERT. NO. DATE '— LIBRATION DATE -1 1QA,,1 GAUGE # fl a0a_1 ►a MODEL&5- 5 SERVICE RESTORED? YES X NO ❑ I certify that this report is accurate, and I have used 11AC 246-290490 approved test methods and test equipment.