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,''i `� AACRA Backflow Testing and Repair, Inc. ������"�� ���������� W������� ���� ������ <br />�� -�'���� (360) 668-1117 <br />WATI,R Nl!RVEYOR L~'vereit ACCOUNT# <br />ASSEM6LY ID/FILE #/UTILITY DLVICG # IVIeter # 60608886 <br />NAMG OF PREMISG Tlle TOwns Commercial ❑ Residentia4 ❑�/ ;� `" <br />SGRVICE aDDRGSS 1 1217 19th Ave. SE Everett ZIP 98204 <br />CONTACT PERSON Tannon Kocheloat� 425 766-0208 �'��� <br />PHONE � � �`;� ; <br />�oc,�T►oN or.�ss�N�BLv NW Corner Bld<�. 9 <br />DO���NSTREaM PROCCSS Domestic Water DCVA � RPBA ❑ PVSA ❑ OTHER <br />NGW INSTALL �✓' E�ISTING � RGPLACEI�IENT '^' RENIOVED ❑ OLD SER.# <br />APPROVED ASSGMBLY? YES �� NO ❑ PROPER INSTALLATION? YES �❑ NO ❑ <br />MAKE OF.ASSEM6LY Conbraco/Apollo y�pnEL DCLF4A SGRIAL NO. 651795 SIZG 1.5" <br />INITIAL DCVA / RPI3A DCVA / RPBA RPBA PVBA / SVBA <br />TGST CtICCK VALVG NO.1 CIIGCK VALVL N0.2 AIR INLGT <br />or�E�rn,a�r PS[D <br />CLOSED TIGHT - CLOSED TIGH"I' (� OPENI:D A7' PSID <br />PASSCU ',__ LEAKGD — LEAKED I_] #1 Cl�[;CK PSID <br />FAILGD ;�, 0.0 PSID 1.7 PSID ���t�G;���Ox? <br />ni� uoT oY�,N CI <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CN�CK VALVC <br />N�W '�'' L� �� _: ❑ � ❑ I�ELD AT PSID ; , . ' <br />PARTS ❑ �`; ❑ - � L�AKLD � <br />AND `- U ❑ ❑ - ❑ <br />_ ❑ _ ❑ _ ❑ CLEANED � ;: <br />REPAIRS REPAIR�D ❑ � , , <br />TCST ,�FTER CLOSED 1'1GHT �: CLOSCD TIGHT ❑� RV EXERCISGD ❑ AIR INLCT PSID <br />ru,N,auzs — LEAKED ❑ orr�rn,aT <br />LEAKED �— ; " � PSID <br />PASSED ;�: <br />FAILCD ,- � 1'6 PSID �•� PSID #� CFirCK� PSID C��K vALV� PSID I <br />� <br />_.__._._____.__-----__._______ __.____. _..--.--. �___--__ ....__.�..__ _____._ ---__._._ .___------._____.____ <br />AIR GAP INSPGCTION: SUPPLY PIPC DIAMCTL+'R _ SEPARATION PASS� ' I'AIL� �I <br />DGTECTOR METER READING ' <br />LEFT SGRVICE AS 1�OUND �solation vah-e: Open j7 Closed i__ ! SOV#1 Open � Closed �� SOV#2: Open �i Closcd �] <br />RLh�IARICS: I <br />LINE PRGSSURE 95 PSI CONFINED SPACE? NO <br />TGSTL'RS SIGNA'TURt�:: ����� Cl'.RT. NO. g5601 DATE 9/12/2015 I <br />TESTI;RS NA�7E PRINTED Gar�� L. Brown 'TESTGRS PHONE #(360�66$-� � � 7 i <br />REPA[RF..D SY: Gary L. Brown �,IC No. BROWNGL909Q nATE 09-12-2015 "'�"` <br />FINAL TEST BY: Gary L. Brown CCRT. NO. B5601 DATE 09-12 20'�5 �� <br />CALIBRATION DATE 11-25-2014 GAUGE # 03050953 NIODEL NIidwest 845 SERVICE RESTORED YES ❑� NO ❑ �`�"- <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. <br />-/r/ � <br />