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�� � AACRA Backflow Testing and Rep inc. ������"�� ���������r �������'� T��� RE���`� <br />������-� `(360) 668-1117 <br />WATER PURVEYOR �verett <br />ACCOUNT# <br />ASSEMBLY ID/FILE #/UTILITY QEVICE # Meter # 60599865 <br />NAME OF PREMISE The Towns Commercial ❑ Residential 0 <br />SERVICL ADDR�SS 11217 19th Ave. SE Everett ZIP 98204 <br />CO1vTACT PERSON Tannon Rocheloau PHONE (425) 766-0208 <br />LOCATION OF ASSEMBLY SW Corner Bld�. 12 <br />DOWNSTREAM PROCESS Pren7ise Isolatioll llCVA ��] RP[3A ❑ PVBA ❑ OTHER <br />NEW INSTALL � EXISTING ❑ REPLACEMENT ❑ REMOVET) ❑ OLD SER.# <br />APPROVGD ASSGMBLY? YES 0 NO ❑ PROPER INSTALLATION? YES � NO ❑ <br />MAKE OF ASSEMI3LY Conbraco/Apollo MODEL DCLF4li ���ittA[. tvo. 659482 SIZE 1.5" <br />INITIAL DCVA / RPT3A DCVA / RPBA RPI3A PVBA / SVBA <br />TEST CHECK VALVE NO.1 CHECK VALVE N0.2 OPENED AT AIR INLET <br />PSID <br />CLOSED T1GHT ❑ CLOSED TIGHT ❑ OPENED AT psy� <br />PASSED � #i CHECK pSjD <br />LEAKED ❑ LEAKED ❑ <br />FAILED � 0.0 p�ID l.$ ps� <br />AIK GAP OK? DID NOT OPEN ❑ <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW d❑ ❑ �� ❑ ❑ ❑ ❑ HELD AT PSII� <br />PARTS ❑ ❑ ❑ ❑ � � LEAKED ❑ <br />❑ ❑ ❑ ❑ ❑ ❑ <br />AND � u ❑ L� u ❑ CLEANED � <br />REPAIRS REPAIRGD ❑ <br />TEST AFTER CLOSED TIGHT C� CLOS�D T[CEIT C� RV GXERCISED ❑ AIR INLET Psj� <br />REPAIRS LEAKED ❑ LEAK�D C_� OP[;NED AT <br />PSID <br />PASS�D � " <br />1.6 PSID 1•g PSID #1 CHGCK PSID CHK VALVE PSID <br />FAILED [] <br />AIR GAP INSPECTION: SUPPLY PIPE DIAMETGR <br />DETECTOR METER R�ADIiVG <br />LEFT SERVICE AS FOUND Isolation valve: Open � Closed ❑ SOV#1 <br />ItEMARKS: <br />SEPAEZATIQN <br />PASS [] FAIL � <br />Open ❑�/ Closed ❑ SOV#2: Open ❑�/ Closed ❑ <br />LINE PRES�URE �� PSI CONEINED SPACE? No <br />TESTERS SIGNATURE: ����� CERT. NO. 65601 DATE 1/22/20'i6 <br />TESTERS NAME PRINTED Gary L. Brown TESTGRS PHOI�i� #(360)668-1117 <br />R�PAIRI;D BY: Gary L. Brown �[� NO. BROWNGL909Q nATE 01-22-20�6 <br />�'INAL TCST BY: Gary L. Br�wn C�RT. No. g5601 I�A�'r 01-22-2016 <br />CALIBRATION DATE 12-04-2015 GAUGG # 03050953 MODEL Midwest �3d5 SrRVICG RESTORGD YES �d NO ❑ <br />I ccrtify that this report is accurate, and I have used WAC 246-2)0-490 approved test inethods and test equipment. � <br />