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

BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT'# NAME OF PREMISE Un Z � (�a � n'1 Y'Yl l�"' � ��'L` � Commercial Residential ❑ SERVICE ADDRESS JA). V-AArli1t\J1-kW Df`JVe— CITY'FV`f-t+f ZIP ,1(ya©1 CONTACT PERSON r t Im M r t CL PHONE c31!!Q) 3r 56,0773 FAX( ) LOCATION OF ASSEMBLYJ:\') rk (1h e In _) I "C_ 5,Q � W %Ck t7 �-.�9 -� j, DOWNSTREAM PROCESS W at f-f- 0.6 C e (' DCVA ❑ RPBA)k PVBA ❑ OTHER NEW INSTALL f,�( EXISTING ❑ REPLACEMENT ❑ OLD SER. # PROPER INSTALLATION? YESn NO ❑ MAKE OF ASSEMBLY W A-W5 MODEIL!�SERIAL NO. 39 1 4b O 2> SIZE ' 1 a 11 DCVA / RPBA DCVA / RPBA RPBA PVBA/SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT3 - � PSI CLOSED TIGHT�j OPENED AT PSID LEAKED ❑ LEAKED ❑ #1 CHECK.PSID PASSED. o V AIR GAP OK? DID NOT OPEN ❑ FAILED ❑ PSID PSID i CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ 13 ❑ 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 X No ❑ Detector Meter Reading REMARKS: TESTERS SIGNATURE: TESTERS NAME PRINTED: Rachel`Finochio REPAIRED BY: FINAL TEST BY: CERT. NO.�� TESTERS PHONE # (20 CERT. NO. LINE PRESSURE bQ_C�_PSI 6 CONFINED SPACE? _DATE 5 a3 )450 7882 DATE DATE '� LIBRATION DATE -1 /Z /toZGAUGE # ] IZO-71 MODELS SERVICE RESTORED? YES NO ❑ I certify that this report is accurate, and I have used Ti'AC 246-290-490 approved test methods and test equipment.