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T� Flow 0 Inc. <br />(206) 551-5242 TEST REPBACI(FLOW PREVENTION ASSEMBLY EORT <br />l+t'T - _ <br />I1 A 1 fn 11 u.l luN 1."It 114r1rli. It Irk. ACCOENT0 <br />...I Mnl.I III nn l a'II TIT) I I of I'It, r a Meer a <br />n %'If tit PRE% Annoy Curb Sh vk all - Bo d Pilielbillse C1.11,11.11lial SO Reldn.wd <br />HNI I( I ADDluss I?21 SG'livcrCn Mnll Ra Everett )IP 98208 <br />Crxt l if PERSON Cunis Bond / pENPrr 4206I i79-7441 <br />l.Or IIIU.\OFASFFAHILY,�a.S�T pjI 1✓ j �/�� C/ / <br />DORa'\'TREAMPROCESS L[/' K�A-Of �� DCVA Fe RPIJA '] PI'RA L CITIIEII <br />NF.NIN'.STALL ❑ EXISTING ❑ REPLACEMENT ❑ REMOVED❑ OLDSERb _ <br />APPROVEDA.SSF.MDLYP�� �1'�6Sillitf NO❑ may/ 1-14OPER INSSTTAAL/jL^A�TION? 11 G ✓ NO <br />MAKE OFASSFMOLI• KI/�MODEL N�Pi/(+'j cERiALN'O. �O/J7 \IL•� <br />INITIAL DCVA/RPDI DCI'A/RPRA ID_RA PNRA/SVIIA <br />TEST CHECK VALVE. NOA CHECK VALVE NO.S AIR INLET <br />r•Cnsn IT �•SIU <br />CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT Ps[ <br />'•ANSED �' LEAKED ❑ LEAKED n ul tra-t 1. I!SID <br />AILED �j PSID PSID tot P. IP Oh:, DID NOT OPEN ri <br />( NEW <br />❑ <br />❑ <br />L <br />❑ <br />31FLOAT <br />PSID <br />PARTS <br />❑ <br />❑ <br />❑ <br />0 <br />J LEANED <br />❑ <br />❑ <br />El <br />❑ <br />Arvn <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ CLEANED <br />❑ <br />REPAIRS <br />REPAIRED <br />❑ <br />IITEsTA�Flq'CLOSEDTIGHT ❑ ICLOSEDTIGHT ❑ <br />REPAIRSLEAKED O LEAKED ❑ASSED <br />FAILED PSN PSID <br />!EXERCISED <br />❑ <br />AIR INLET <br />PSID <br />ENEDAT <br />PSID <br />CHECK <br />PSID <br />CHK VALVE <br />PSID <br />REAPI,V.SPEC KEV. SOPPLYPIPEDIAMETER SEPARATION PASS❑ FAD.❑ <br />'TEC OR AIFTER READING <br />T SERVICE AS FOUND Isolation Lithe: OPeQX Closed ❑J SOV#1: Open ,Kl_Cinsed ❑ SOV42: Open X_Cimcd ❑ <br />ARKS: <br />'RSSIGNA7'1111E: I —1+-S7i— <br />tS NAME PRINTED •IRIIIeS SDIDD <br />ED BY: James Saxon <br />.ST BY: James Saxon <br />TION DATF I11-05-2023 GAUGE# 0518/292 <br />— LINFPRESSURE�PSI CONFINEDSPACET No <br />CERT. NO, 85737 DATE 9/20/2023 <br />TESTF.RSPHONE# (206)551-5242 <br />_LIC NO. SAXONJM879PG DATE <br />_CERT. NO. 85737 DATE <br />MODEL Mide'efl 835 SERVICE RESTORED YES )UO ❑ <br />eenRy Ihar_this report is amvale, and i have Need 1rVAC24629(1490 appmved test methods and Test equipment. <br />Flow Six Inc. <br />RACKFLOW PREVENTION ASSEMBLY TEST REPORT <br />1F_ (208) 551-5292 <br />Will l Itll Ilk I 4M Ierell l•ubIIL W1rtA. Act (it NI •• <br />\..I HUI\ II, 1 11 1 •,.I In l l\III I \ <br />Mile, It <br />NuO M IRI10. ♦n.�I „tl. +I,.'d� <br />.... t'.dl-Bond MrImbin mmoda V. la..:d.mm1 <br />v IN u 1 \Dlliu SN I L I �1 I nacP Melt <br />P-.n Everett Or 98208 <br />Ilrvl It I I'IN.n♦ ul i.RanJ <br />PIONE 1 <br />IO1 �1� <br />\GOG)779-7i <br />` �1 �� p <br />( Scott AI <br />\Ill la nl \.H%IlNN :i n`a.� <br />JILT /6-Q <br />I)I1NA.11tl dV tUILF\_l �N,�--+�Li <br />�� IILVA II1PM Cl_PVRA f OT11LR <br />NI\I R.I VI >� IXIl9NG I', REPLACEMENT <br />❑ REMOVFA i) OLOSER.4 <br />it l It0\ 1.1"' \Y9�"fv NO-1 <br />PROPFRINSTALLLLATTiON?NES yNO <br />(1%(/(C S <br />��/�qq + <br />�SF.RIAL <br />J <br />\ \. (l� l <br />MOOEI, rti "�i I(.0 NO.qN1 I Size <br />fit 'A/12"A <br />OCVA I11PRA RPRA PVRA I%VRN <br />INIITAI. <br />IT CIS VAI.VENO.I <br />CHECK VALVE NO.2 MR INLET <br />-1 EST <br />tn•ENEn At +STD <br />CL(ISI.1) IN:Ut 'tit- <br />CLOSEIITI(i11T OPENED AT <br />p$lll <br />PASSED <br />❑ <br />NI CHECK 4T •D <br />=l <br />,+SID <br />LE,A/K(IT, '/ <br />FAILED. CI /11MT PSID <br />LIi�AKFO <br />/IyU}� PSID PmeAPOK? <br />Q.iJ 010 uoT oecN=1 <br />NEW <br />❑ <br />❑ <br />❑ <br />-1 <br />PARTS <br />❑ <br />❑1- <br />❑ <br />❑ <br />J <br />L <br />AND <br />❑ <br />❑ <br />n <br />n <br />REPAIRS <br />PEST AFIEIi ICLOSEDTIGHT ❑ CLOSERTIGIIT ❑ <br />REPAIRS LEAKED ❑ LEAKED O <br />PASSED ❑j <br />RAILED n TSID PSID <br />AIR GAP INSPECTION: SUPPLY PIPE DIAMETER <br />DETECTOR METER READING <br />❑ r' <br />❑ � <br />CLEANED <br />❑ <br />REPO ROD <br />7% <br />R\ICFRCm1) <br />_ <br />MR1NLT.t <br />P$iD1 <br />\l <br />PSID <br />IOPENED <br />III ClIFCK <br />PSID <br />CRKVAINE <br />TSID <br />SEPARATION PASS❑ FAIEQ <br />LEFT SERVICE AS FOUND Isnlatiyn vnlvC Open PQ Cloxed :❑ SOV#lt Open ti-�Khead ❑ SOVh2: Open p5^.`L'losed [_ <br />REMARKS <br />LINE PRESSUREJ�__PSI <br />CONFINED SPACE^. No 1 <br />TESTERS SIGNATURE: <br />q <br />I'j L`-T <br />CERT. NO. 85737 <br />DATE 912012023 <br />TESTERSNAMEPRINTED JRIIIL•SSaxtn <br />TESTERSPITONEH <br />(206)55b5242 <br />REPAIRED BY: JameS SaXOn <br />LIC NO. SAXONJM879PG DATE <br />FINALTESTRY: James Saxon <br />CERT. NO. 85737 <br />DATE <br />CALIBRATION DATE 01-05-2023 GAUGER 05181292 MODEL Mlduesl835 SERVICERESTOREDY'ES T, NO `❑ <br />I Tedify that this report is accurate, and 1 have used WAC 2tp-Zm-090 approved test mehods and test equipment. <br />