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" ;'; AACRA Backflow Testing and Repair, �nc. �����`-�� �RE�ENTION ASSEMBLI( TEST REPORT <br />:�^��� � (360j 668-1117 <br />WATER PLJRVEI'OR Everett ACCOUNT # <br />.ASSE:�iBL�"ID/FILE#/UTILITYDEVICE# Meter# 60608896 <br />_ <br />N,�1�1E OF PRE1�71SE The Towns Comme��cial �._, Residential ��, <br />SER�"ICE :�DDRESS 1 121 7 19th Ave. SE Everett ZiP 9g204 _ <br />CONT:ICT PERSON l�annon Rocheloau PHONE �`�2�) 766-0208 �� <br />LOCATION OF:ISSE�IBL1' SL Corner Bld<,. 18 � <br />DO�� NS7�RL.A�1 PROCESS Domestic Water DC�'A �. RPBA u PVBA �._; OTHER <br />NE��' I;�ST:�LL � E\ISTINC _ REPLACE�7ENT _ RE1�90VED [J OLD SER.# <br />APPRO�'ED .4SSE�IBL}'? 1'GS � NO ,— PROPER INSTALLATION' YES (� NO �_ <br />tiitlkE OF .aSSE�IBLI' Conbrac0/Ap0110 110DEL DCLF�A seuta� �o. 626379 SIZE 2�� <br />DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA <br />IN[TIAL AIR INLET <br />CHECK V�L�'E NO.1 CHECK VAL�'E N0.2 <br />TEST OPE\ED AT PSID <br />CLOSED TICHT '�: CLOSED TIGHT ��i, OPENED AT PS[D <br />PASSED � -- r-, #t CHECK PSID <br />LEAKED __ LEAKED � <br />FAILED — 1.6 PSiD i•� PSID <br />AlK G,aP OK? DID \OT OPEN � <br />CLEAN REPIJaCE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK �'ALVE <br />__._ _ - U HELD AT PSID � ' <br />NEw - [_� � � _ <br />PARTS C� _ — L—� LEAKED ❑ ..� <br />J <br />_, ,_ _ , <br />� rJ� <br />_ � i _ � _ �_ E. <br />AN D _ �. __ - -- - <br />, _� __ __ I 1 CLE.4NED ❑ <br />REPAIRS REPAIRED ❑ <br />_, <br />T[�:S"1' ,�F�rriz CLOSED TIGHT _ CLOSED TIGHT - <br />- RV E?�ERCISED i� AIR INLET pSYp <br />RF;P:�IRS — � � <br />LEAKED __ LEAKED �_i OPETF,D AT ps�p <br />PASSED - ! <br />PS1D PSID #� CE�ECh PSID CHK V,�[.vE PSIU ', <br />FAILED - � <br />-- ------------- -------_ -- - -- ------- ------ <br />AIR GAP 1NSPECTION: SUPPLY PIP@ DIAI�IETER SEPARATION PASS;_ FAIL[_� I <br />DETECTOR METER READINC <br />LEFT SERVICE AS FOUND �solation �ah�r. Open '.i� Closed - SOl�#1 Open �.il Closed ❑ SOV#2: Open ;;i! Closed (] <br />REf��IARKS: <br />LINE PRESSURE 93 PSI CONFINED SPACE? No <br />TESTCRS SIGNATURE: �%x��{� CEUT. NO. B5601 DATE 9/12/2015 <br />TESTERS NAME PRINTED Ga�y L. Brown TCSTERS PHONE #(360)668-1117 <br />,. <br />REPAIRED BY: LIC NO. DATE <br />� <br />FIN,4L TEST Bl': CERT. NO. DATE �- <br />; <br />CALIBR.ATION DATE 1 I-25-2014 CAUGE # 030509�3 NIODEL Midwest 845 SERVICE RESTORED YES ❑� NO ❑ . <br />,� � <br />x <br />I certify that this report is accurate, and I have nsed 4VAC 246-290-�90 approved test methods and test equipment. <br />�� <br />����M� <br />