1523 132ND ST SE FATBEE 2024-10-15

Stop Backflow BACKFLOW PREVENTION ASSEMBLY TEST REPORT (425)923-7585 WATER PURVEYOR Everett ACCOUNT# ASSEMBLY ID/FILE#/UTILITY DEVICE# Meter# NAME OF PREMISE Fat Bee Cafe Commercial 0 Residential ❑ SERVICE ADDRESS 1523 132ND ST SE Everett zip 98208 CONTACT PERSON PHONE (816) 263-0815 LOCATION OF ASSEMBLY on back wall DOWNSTREAM PROCESS Premise Isolation DCVA ❑ RPBA 0 PVBA ❑ OTHER NEW INSTALL ❑D EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES 0 NO ❑ PROPER INSTALLATION?YES d❑ NO ❑ MAKE OF ASSEMBLY Wilkins MODEL 375XL SERIAL NO. AJAX1257 SIZE 1�� INITIAL DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA CHECK VALVE NO.1 CHECK VALVE NO.2 AIR INLET TEST OPENED AT 3.5 PSID CLOSED TIGHT W CLOSED TIGHT P1 OPENED AT PSID PASSED #1 CHECK 9.2 PSID LEAKED El LEAKED El FAILED ❑ TIGHT PSID TIGHT PSID AIR GAP OK? yes DID NOT OPEN CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑ AND ❑ ❑ ❑ ❑ ❑ ❑ El El El El El ElCLEANED F REPAIRS REPAIRED ❑ TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID PASSED ❑ FAILED ❑ PSID PSID #1 CHECK PSID CHK VALVE PSID AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION PASS❑ FAIL L DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open d❑ Closed ❑ SOV#1: Open 0 Closed ❑ SOV#2: Open Closed ❑ REMARKS:Needs to install drain LINE PRESSURE 85 PSI CONFINED SPACE? No TESTERS SIGNATURE: CERT.NO. B6284 DATE 6/1/2024 TESTERS NAME PRINTED Craig Allenfort TESTERS PHONE# (425)923-7585 REPAIRED BY: LIC NO. DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE 03-29-2024 GAUGE# 07201781 MODEL Midwest 845 SERVICE RESTORED YES ❑v NO ❑ I certify that this report is accurate,and I have used WAC 246-290490 approved test methods and test equipment.