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r=� �� AACRA Backflow Testing and Repair, �nc. B�C�SFLOW P�EVENTIOI� A�SEMBLY TEST REPORT <br />�--�� -� (360) 668-1117 <br />WATER PURVEYOR Silver Lake ACCOUNT# <br />ASSENIBLY ID/FILE #/UTILITY DEVICE # Meter # 60599847 <br />NAME OF PREMISE The Towns Commercial ❑ Residential [� <br />SERVICE ADDRESS 1 1217 19th Ave. SE Everett ZIP 98204 <br />CONTACT PERSON Tannon Rocheloau pyn;�E (425) 766-0208 <br />LOCATION OF ASSEMBLY E. Side of Bld�. 5 <br />DOWNSTREAM PROCESS DomeStic Water DCVA ,�i RPBA ,! PVBA �'_ _ pTHER <br />NEW INSTALL l�� EXISTING C' REPLACEMENT '. REMOVED '�I OLD SER.# <br />APPROVED ASSEMBLY? YES C� NO �_l PROPER INSTALLATION? YES !di NO !__! <br />MAKE OF ASSEMBLY Conbraco/Apollo n,�ODEL DCI,F4A SERI,a� No. 634808 SIZE 2�� <br />INITIAL DCVA / RPBA DCVA ! RPBA RPBA PVBA / SVBA <br />CHECK VALVE NO.I CHECK V.ALVE N0.2 A[R INLET <br />TEST oPEVE� :�T PSID <br />CLOSED T1GHT �! CLOSED �TIGHT �; OPEtiED AT PSID <br />PASSED ��! LEAKED �_i LEAKED - #t CI�ECK PSID <br />FAILED ;^; .1IR GAP OK? DID NOT OPEN ❑ <br />_ 1.6 PSID 1.6 PSID <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW I _; __, !� '� � �__ ; � fiELD AT PSID <br />PARTS -- �-� � - _ - - i,EnhEn ❑ <br />C! _. _ ,_ <br />AN D , -- <br />- � _ - - '-- c�.e:��F� ; - <br />REPAIRS — <br />REPIIRED <br />TEST AFTER CLOSED TIGHT --I CLOSED TIGHT . RV F,XERCISED �_ AIR INLE;T PSID <br />REPAI RS _ <br />LEAKED [_i LEAKED _.. oYE��� nr PSID <br />PASSED r J <br />FAILED � PSID PS[D #t CHECk PSID �Hh v,at.�'E PSID <br />41R GAY tNSPECTIUN: SUPPL,Y PIPE D1�il�lE']�EK 5t�PARA7�[ON <br />DETECTOR ME"I'ER RF.ADING <br />LEFT SERVICE AS FOIJND �solation valvr. Open ,� Closed ._ SOV#1 Open ',';i Closed ',__ <br />RENIARI<S: <br />TESTERS SIGNATURE <br />TES`TERS NAME PRINTED <br />REPAIRED BY: <br />FINAL TEST BY: <br />i':1SS, I�:VLi <br />SOV#2: Open �; Closed ❑ <br />LINE PRESSURE �� PSI CONFINED SPACE? NO <br />�1X..8�� :� � <br />CERT. NO. B5601 DATE 5/30/2015 �'�' i <br />L. Brown TESTERS PHONE # (360)668-1117 <br />LIC ti0. DATE <br />�r. �vo. <br />DATE <br />CALISRATION DATE 11-25-201d GAUGE # 030i09i3 ti�onE�� .Niidwest 845 SERVICE RES"1'ORED YES !�� NO ;. <br />I certify that this report is accurate, and I have used 4VAC 246-29U-190 appruved tes-t methods and test equipment. <br />r <br />