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LEFT SERVICE AS FOUND Isolation valve: OPm 2 Closed ❑ SOV#1: Open ©Closed ❑ SOV#2: Open 2 Closed ❑ <br />REMARKS: Removed a large amount of gravel and grit from both checks and assembly. Retested and passed. <br />LINE PRESSURE 80 PSI CONFINED SPACE? NO <br />TESTERS SIGNATURE:CERT. NO. B5737 DATE 2/21/2023 <br />TESTERS NAME PRINTED James Saxon TESTERS PHONE # (206)551-5242 <br />REPAHREDBY: James Saxon LIC NO. SAXONJM879PG DATE 02-21-2023 <br />FINAL TEST BY: James Saxon CERT. NO. B5737 DATE 02-21-2023 <br />CALIBRATION DATE 01-05-2023 GAUGE 05181292 MODEL Midwest 835 SERVICE RESTORED YES 2 NO ❑ <br />I cemry that this reportis accurate, and I have used WAC246-290A90 approved teat methods and test equipment. <br />Flow Six Inc. BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br />(206) 551-5242 <br />WATERPURVEYOR Everett Public Works ACCOUNT <br />ASSEMBLY ID/FILE NUTILITY DEVICE # Meter # <br />NAME OF PREMISE New Install -Baker Heights Commercial ❑ Residential 2 <br />SERVICE ADDRESS 272514th St. Everett Zip 98201 <br />CONTACT PERSON Frederick Brindle- Edmonds plumbing PHONE (206) 920-8000 <br />LOCATION OF ASSEMBLY Riser room of 2725 <br />DOWNSTREAM PROCESS Domestic Water DCVA 2 RPBA ❑ PVBA ❑ OTHER <br />NEWINSTALL 2 EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SERN <br />APPROVED ASSEMBLY? YES 2 NO ❑ PROPER INSTALLATION? YES 2 NO ❑ <br />MAKE OF ASSEMBLY Watts MODEL I F007M1 OT SERIAL NO. 082922 SIZE r <br />INITIAL <br />DCVA/RPRA <br />CHECK VAI VF <br />NOA <br />DCVA/RPRA <br />CHECK VAI VF <br />NO.2 <br />BABA <br />PVRA/SVRA <br />AIR INLET <br />TEST <br />PENED AT PSID <br />CLOSED TIGHT <br />2 <br />CLOSED TIGHT 2 <br />OPENED AT <br />PSID <br />PASSED 2 <br />#1 CHECK PSID <br />LEAKED <br />❑ <br />LEAKED <br />❑ <br />DID NOT OPEN <br />❑ <br />FAILED ❑ <br />2.4 <br />PSID <br />2.6 <br />PSID <br />AIR GAP OK? <br />CLEAN REPLACE <br />PART <br />CLEAN REPLACE <br />PAU <br />CYAN REPLACE PART <br />CHECK VALVE <br />NEW <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />HELD AT <br />PSID <br />PARTS <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />LEAKED <br />❑ <br />El El <br />El El <br />El El <br />AND <br />❑ ❑ <br />❑ ❑ <br />❑ ❑ <br />CLEANED <br />❑ <br />REPAIRS <br />REPAIRED <br />❑ <br />TEST AFTER <br />CLOSEDTIGHT <br />❑ <br />CLOSED TIGHT ❑ <br />RVEXERCISED ❑ <br />AIR INLET <br />PSID <br />REPAIRS <br />LEAKED <br />❑ <br />LEAKED <br />❑ <br />OPENED AT PSID <br />PASSED ❑ <br />FAILED ❑ <br />PSID <br />PSID <br />#ICHECK PSID <br />CHK VALVE <br />PSID <br />AIRGAPINSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASSE] FAIL❑ <br />DETECTOR METER READING <br />LEFT SERVICE AS FOUND ImIaBon eater: OPeB 2 Closed ❑ SOV#1: Open [a Closed ❑ SOV#2: Open 2 Closed ❑ <br />REMARKS: <br />LINE PRESSURE 80 PSI CONFINED SPACE? NO <br />TESTERS SIGNATURE: �'—��^—T CERT. NO. B5737 DATE 2/21/2023 <br />TESTERS NAME PRINTED James Saxon TESTERS PHONE # (206)551-5242 <br />REPAHREDRY: James Saxon LIC NO. SAXONJM879PG DATE <br />FINAL TEST BY: James Saxon CERT. NO. B5737 DATE <br />