10217 19TH AVE SE DR SHARMA 2024-11-15

Backflow American (503) 2894745 1649700867 Assembly Backflow Pordand, OR 9717E AVE. NEW Test Report TESTING • REPAIRS Services ❑ EXISTING INSTALLATION ❑ REMOVED Property ❑ REPLACEMENT Owner: Everett Dental Phone: Mailing Address: City: State: _ _ Zip: Assembly Address: 10217 19th Ave SE Everett WA OR.P.B.A ❑D.C.V.A ❑R.P.D.A ❑D.C.D.A [7]P.V.B.A [-]S.V.B.A ❑A.V.B ❑ AIRGAP Size: 0.50 Make: Watts Model: LF009QT Water Serial Purveyor: Everett Number: 79953 Assembly Electrical room Location: REDUCED PRESSURE ASSEMBLY P.V.B.A S.V.B.A INITIAL TEST AIR INLET CHECK INITIAL DOUBLE CHECK #1 CHECK 8.0 CHECK #1 PRESS DROP MIN 5 PSID TIGHT I ❑d PASSED 0 FAILED ❑ OPENED AT: PRESS DROP TEST RESULTS RELIEF VALVE I PSID OPENED AT 3.2 I LEAKED MIN 2 PSID I CHECK #2 PSID PSID DATE: 6/5/2024 TIGHT ❑d RELIEF VALVE PSID PASS ❑d FAIL El LEAKED ❑ DID NOT OPEN ❑ FAILED ❑ SYSTEM 55 PSI Shut Off #1 Found Off, Shut Off #2 Found Off, Upstream Shut off Found Off, COMMENTS REPAIRS AND / OR PARTS REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A AFTER REPAIRS DOUBLE CHECK DATE: TEST #1 CHECK AFTER PRESS DROP ICHECK #1 OPENED AT: PRESS DROP REPAIRS MINSPSD TIGHT ❑ PSID RELIEF OPENED (CHECK #2 PSID PSID PASSED ❑ Mmzvs TIGHT ❑ PSID TEST WAS PREFORMED IN ACCORDANCE TO USC LOTH EDITION PROCEDURES IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS. WATER METER # DETECTOR METER READING B6758 Washington CERT# Kao Saechao )2461060161 TESTERS PRINTED NAME GAUGE # American Backflow Services (877) 950-2468 10/17/2023 COMPANY NAME PHONE # GAUGE CALIBRATION DATE ADDR5623 SE Center St, Portland, OR 97206 SERVICE RESTORED TRIAL MODE - Click here for more information