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- �° AACRA Backflow Testing and Repair, Inc. ������'�� �RE�/ENTION ASSEMBLY TEST REPORT <br />G^-'�'�-�^.i � (360) 668-11 � 7 <br />�'VATER PUR��EI'OR Everett ACCOUNT # <br />.4SSE:�1BL1' ID/FILE #/UTILITY DEi�ICE # Meter # 60608896 <br />N.aME OF PREM11ISE The Towns Commercial ;,.._, Residential �.�� <br />SEtti- ICE :�DnREsS 1 1217 19th A��e. SE Everett zIP 9g204 <br />C�ONTAC'T PERSO� l�annon Roclleloau PHONE (425) 766-0208 <br />n, <br />LOC.ATION OF:ISSGIIBLI' SE CO1'ilet' Bld<?. l8 <br />DO�� NS"i'RE.a��i PROCESS DOmeStiC V4'atel' DC�'A � RP6A �_i PVBA i_� OTHER <br />NE��' I�ST:�LL � �SISTINC __ REPLACE��9E!�T _ REn'9OVGD `.J OLD SER.# <br />APPRO�'ED ,4SSE�iBLI'? 1'ES � NO ` PROPER INS7�ALLATION' YES (✓� NO <br />���ahE oF .assE��et.�' Conbiaco/A op Ilo �tonE� DCLE�A sER�A� �o. 626379 s�zE 2" <br />DCVA/RPBA DC�'A/RPBA RPSA PVBA/SVBA <br />1NITIAL AIR INLET <br />CHECK �'ALVE NO.1 CFIECK VAL�'E N0.2 <br />TEST OPE\ED AT PSID <br />CLOSED TIGHT '� CLOSED TIGHT ���i OPE'�ED:1T pS[D <br />PASSED :� - #i CHECK PSID <br />LEAKED — LEAKED i- <br />FAILED .- 1.6 PSID �-� PSID a1x GAP OK? DID NO"T OPE1' [; <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />`--, IIELD AT PSID "" <br />NEW _ IJ _ J — �J , <br />PARTS C� _ — r� LEAKED ❑ ..� <br />J <br />;• <br />_ _ _. . � <br />,.._ , ,... , <br />_ � I — -� — �., <br />AND - r, _ _. -- j CLE.4NED ❑ <br />REPAIRS REPAIRED ❑ ,, <br />T[�;ST .�F"I'GK CLOSED TIGHT _ CLOSED T1GH-f __, RV E?�ERCISED � AIR INLET PSID <br />RF,P:URS — -� • <br />LEAKED _ LEAKED `� oPt;�En.a'r PSID <br />PASSED - <br />FAILED -, PSID PSID #t CFiECh PSID CHK V.�[,vE PSID <br />AIRGAP INSPECTION: SLIPPLY P[PE DIAI�IETGR SEPARATION P:�SS;_ F,ait,�__� <br />DETECTOR 1�1ETER READING <br />LEFT SERVICE AS FOUND �solation �aivr. Open '�� Closed . SOV#1 Open �,�, Closed ❑ SOV#2: Open � Closed j] <br />REMARKS: <br />LINE PRESSURE 93 PSI CONFINED SPACE? NO <br />TESTERS S[GNATURE: �x��� C�xT. vo. 85601 DATE 9/12l2015 <br />TES"I'ERS NAME PRI;VTED Gary L. Brown TESTERS PHONE #(360)668-1117 <br />,. <br />REPAIRED BY: L1C NO. DATE <br />�. <br />FIN.4L TEST Bl': CERT. NO. DATE a- <br />,,A <br />C,aLIBRA"TION DATG 11-25-201� GAUGE # 030509�3 :VIODEL 1�7idwest 845 SERVICE RESTORED YES � NO ❑ <br />R, <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. <br />� <br />�/ N� <br />