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� AACRA Backflow Testing and Re�nc. <br />���:��� '(360) 668-1117 <br />BACKFLOW PREVENT101 <br />BLY TEST REPORT <br />WATER PURVEYOR �verett ACCOUNT # <br />ASSEMBLY ID/FILF, #/UTILITY DEVICE # Meter # 60599865 <br />NAME OF PREMISE Tlle Towns Commercial ❑ Residential ❑d <br />SERVICE ADDRESS 1] 217 19t11 Ave. SE Everett ZIP 98204 <br />CONTACT PERSON Tannon Rocheloau PHONE (`�'S) 766-0203 <br />LOCATION OF ASSI:MBLY SW Col'n�r Bld�. 12 <br />DOWNSTREAM PROCESS Premise Isolation UCVA �� RP[3A [] PVBA ❑ OTHER <br />NEW INSTALL ❑d EXISTING [_] REPLACEMI;NT j_] REMOVEU U OLD SER.# <br />APPROVED ASSEMBLY? YES � NO ❑ PROPER INSTALLATIOP�? YES ❑d NO ❑ <br />MAKE OF ASSEM[3LY Conbraco/Apollo MODEL DCLI�4/1 SERIAL NO. 659482 SIZE 1.5'� <br />INITIAL DCVA / RPBA DCVA / RPBA RPl3A 1PVBA / SVBA <br />CHECK VALVE NO.1 CHF.CK VALVE NO.Z AIR INLET <br />TEST OPENED AT PSID <br />CLOSED T1GHT ❑ CLOSED TIGHT [_] OPENF,D AT pSjD <br />PASSED ❑ LEAKED ❑ LEAKED � #I C►-�FCx�._,_„_ �_�SID <br />FAILED � 0.0 PSID �•g PSIll AfR GAP OK:'� <br />DID NOT OPEN ❑ <br />CLEAN REPLACE PART QEAN REPLACE PART QEAN REPLACE PART CHECK VALVE <br />NEW � ❑ �� ❑ ❑ LJ ❑ HELD AT PSID <br />PARTS ❑ ❑ C� ❑ �—� �� LEAKED � <br />�_� � L � ❑ �__� ❑ <br />AND <br />�J L� C� �__I L_� L_� CLEANED ❑ <br />REPAIRS <br />RGPAIRCD � <br />TEST AFTER CLOSED TIGHT !�/� CLOSED TIGHT [�I RV I:XF.RCISGD � � AIR IPVLET PSID <br />REPAIRS <br />LF.AKED ❑ LEAKF.D Cl opt?N�;�.a'r PSID <br />PASSED � <br />FAILED � 1'6 PS[D �•g PSID #� CI�ECK PSID cHK `VALVE PSID <br />AIRGAP INSPECTION: SUPPLY PIPE DIAMETER � SEPARATION � PASS� FA[L� <br />DETECTOR METER READING <br />LEFT SERVICE AS FOUND �solation valve: Open '] Closed ❑ SOV#1 Open [� Closed ❑ SOV#2: Open 0 Closed ❑ <br />REMARKS: <br />LINE PRESSURE 90 PSI CONFINED SPACE? No <br />TESTERS SIGNATURE: �,���� CGRT. NO. B5601 DATE 1/22/2016 <br />TESTERS NAME PRINTED �iary L. Brown TESTGRS PHONG #(360)668-1117 <br />REPAIRED BY: Gary L. Brown ��C Np. BROWNGL909Q DATC 01-22-2016 <br />FINAL TEST BY: Gary L. Brown CLKT. NO. B5601 DATE 01-22-2016 <br />CALIBRATIOIV DATE 12-04-2015 GAUCI; # 03050953 MOUEL Midwest 845 SEI2VICE RESTORCD YES � NO ❑ <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. ,/�j <br />� <br />