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Service Ticket No. :ST00371802 <br /> Date : 12/17/2024 <br /> PYE * Frequency: Annual <br /> Service Ticket No. : ST00371802 <br /> p4rige]3 BARKER <br /> Inspection Contract No. <br /> FIRE 6 SAFETY-EST. 1946 PO No. : <br /> Equipment Location : Water Manifold to the left of <br /> Backflow Inspection Report <br /> Property McDonald's#23463 Owner McDonald's#23463 <br /> Address 7920 Evergreen Way Address 7920 Evergreen Way <br /> City Everett City Everett <br /> State WA State WA <br /> Zip 98203 Zip 98203 <br /> Phone 4253536267 Phone 4253536267 <br /> BACKFLOW INSPECTION SUMMARY <br /> Domestic: 1 Fireline: 0 <br /> Irrigation: 0 <br /> DEFICIENCIES <br /> Backflow Inspection - In kitchen to the left of dishpit- protecting Multiplex <br /> •Deficiency Found Check valve 1 failed <br /> BACKFLOW INSPECTION - Location: In Kitchen To The Left Of Dishpit - Protecting Multiplex <br /> Assembly Located Inside Building <br /> Type of backflow Domestic <br /> Assembly Type RP <br /> Time of Test 01:56pm <br /> Manufacturer Wilkins <br /> Model 845 <br /> Size .50 <br /> Serial Number AJBI0512 <br /> Inspection Type Initial Inspection <br /> Reason Tested New Assembly <br /> Service Meter Number NA <br /> Supply Line Size .50 <br /> Line PSI 70 <br /> Isolation or Containment N/A <br /> **Check Valve#1 Closed Tight or Leaked Leaked <br /> PSI Differential Across Check Valve#1 0.0 <br /> **Check Valve#2 Closed Tight or Leaked Not Tested <br /> •735 E Fairhaven Ave•Burlington WA•98233-1914 <br /> Backflow Inspection Page 2 of 3 <br />