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�� �� AACRA Backflow Testing and Re� inc. ������"�� ���������` 1�����iL°� ���� RE���� <br />��--� ' (360) 668-1117 <br />WATER PURVEYOR Everett <br />ASSEM�LY ID/FILE #/UTILITY DEVICE # <br />NAME OF PREMISE The Towils <br />SERVIC� ADDRESS 11217 19th Ave. SE <br />CONTACT PERSON Tannon Rocheloau <br />LO�CATION OF ASSEMBLY SW Corner Bldg. 12 <br />ACCOUNT# <br />Meter # 60599865 <br />Commercial ❑ Residential � <br />Everett ZIP 98204 <br />N}�o�E (425) 766-0208 <br />DOWNSTREAM PROCESS Premise Isolatlon DCVA � RPBE! ❑ PVBA ❑ OTHER <br />NGW INSTALL � EXISTING ❑ R�PLACrM�NT [� REMOVGD ❑ OLD SGR.# <br />AP�'ROVF;D ASSEMBLY? YES I�� NO ❑ PROPER INSTALLATION? YES � NO ❑ <br />MAKG OF ASSGMI3LY C�nbraco/Apollo �ODEL DCLF4A. SI?RtAL NO. 659482 SIZE 1.5" <br />INITIAL DCVA / RPBA DCVA / RPBA RP[3A PVBA / SVBA <br />CHECK VALVF, NO.1 CHECK VALVE N0.2 AIR INLET <br />TEST OPENED A'T PSID <br />CLOSED T1GHT ❑ CLOSED TIGHT ❑ OPENED AT ps� <br />PASSED ❑ LEAKED ❑ LEAKED � #i CHECK ps� <br />AIR ChP OK? DID NOT OPEN ❑ <br />FAILED � 0.0 P�� 1.8 PSID --- <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW ❑.r ❑ �� ❑ ❑ CI ❑ xFLn a►T PSID <br />PARTS ❑ ❑ ❑ ❑ � � LEAKGD ❑ <br />AND � � � � � L � <br />❑ ❑ ❑ ❑ ❑ [� CLEANED ❑ <br />REPAIl2S RGPAIRLD ❑ <br />TES"C AFTER CLOSED TIGHT ❑d CLOSLD TIGHT [� }tV EXERCISEU ❑ AIR INLET PSID <br />REPAIRS <br />LEAKED ❑ LEAK�D ❑ OPENED A7' PSID <br />PASS�D � � <br />1.6 pSID 1•8 PSID #� c�[Ecx YSID CHKVALVE PSID <br />FAILED � <br />AIR GAP INSP�CTION: SUPPLY PIPE DIAMETER �EPAItATION PASS � FAIL� <br />DETECTOR METER READING <br />LEFT SERVICE AS FOUND jsolation valve: Open � Closed ❑ SOV#1 Open � Closed ❑ SOV#2: Open � Closed ❑ <br />REMARKS: <br />LINE PIdESSURE 90 PSI CONFINED SPACE? No <br />TESTERS SIGNATURE: ����� CERT. NO. ��601 pAT� 1/22/2016 <br />TESTERS NAME PRINTED �ary L. Brown TESTGRS PHONG #(360)668-1117 <br />REPAIRED BY: Gary L. Brown LIC NO. BROWNGL909Q DA7'� 01-22-2016 <br />FiNAL TEST BY: Gary L. Br�wn C�RT. r�o. �560'I nA7'c 01-22-2016 <br />CALIBRATIOIY DATE 12-04-2015 GAUGG # 03050953 MODF.L Midwest f34S SERVICG RGSTORED YES (] lY0 ❑ <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipinent. �� <br />7 <br />