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"�=;;� <br /><i.. <br />a � AACRA Backflow Testing and Repair, �nc. BACKELOVY PiZEVEI►1lTION QSSEMBLY TEST REPORT ,; <br />�� (360) 668-1117 ' �; � <br />='� <br />WATER PURVEYOR Silver Lake <br />ASSEMBLY ID/FILE #/UTILITY DE�'ICE # <br />NAME OF PREMISE The Towns <br />SERVICE ADDRESS 1 1217 19th Ave. SE <br />CONT,ACT PERSON Tannon Rocheloau <br />LOCATION OF ASSEivigLl' E. Side of Bld�. � <br />ACCOUNT# <br />Nteter # 60599847 <br />Commercial Residential ✓ <br />Everett Z�P 98204 <br />PHOtiE (425) 766-0208 <br />DOWNSTRE.AM PROCESS Domestic Water �c�va .i RPBA PVBA OTHER <br />NEW INSTALL .� E�ISTtNG ` REPLACE:titE\T REb10�'ED . OLD SER.# <br />APPRO�'ED ASSEIIBLY'? 1'ES _✓_ NO PROPER 11'STALLAT101'' 1'ES ./ \O _ <br />MAhE OF .aSSE!�iBLI' Conbraco�Apollo ��pp��, DCI.F�A SERI.aL ti0. 6�4808 SI"LE ��� <br />II�i1T1AL DCV.A / RPBA DCVA / RPBA RPBA PVBA / SVBA <br />CHECK VALVE NO.I CHECK �_aLVE 10.2 AIR INLET <br />TEST OPE\ED .1T PSID <br />CLOSED TIGHT �. CLOSED TIGHT � OPE�ED.aT PSID <br />PASSED i�'; _ - at cii�C[: PSID <br />LEAKED � LEAKED __._ <br />FAILED ,� 1.6 PSID 1�6 pS�D ��a G:aP oh� DID NOT OPEN ❑ <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK � ALVE <br />NEW -- - _ ►�ELD:�T PSID <br />PARTS =- - � - —� �,GAhED ' <br />AND __ r_ <br />c�t�::��F,n <br />REPAIRS Rr�,P:�IRE� <br />TEST:IF"i'F;R CLOSED TICHT _ CLOSED "I'IGHT ___ R�' EaERC[SED ;�IR I�LEf PSID <br />REP;� I RS - - -_ <br />LEAKED LEAKED U��E�ED.�7� PSID <br />PASSED <br />FAILED PStD PSID #� <���-��h PSID � ��h �.ai.�'E PSID <br />AIRGAP INSPECTION: SUPPLti' PIPE DIA1'IETER SEP.4RATION �'�S� �' ���-'_ <br />DETECTOR METER RE.4DING <br />LEFT SERVICE AS FOUND �solation �ahe: Open ,� Closcd SO� #1 Open _,i_ Closed . SOV#2: Open ,� Closed _ <br />REMARKS: <br />LItiE PRESSURE 85 PSI CONFINED SPACE? NO <br />TESTERS SIGN.4TURE: �x��� cER�r. �o. B5601 DATE 5/30/2015 <br />��:;' <br />TESTERS NAME PRI!�TED Gary L. Brown TESTERS PHOtiE #(360)668-1117 <br />REPAIRED BY: LIC ti0. DATE <br />FINAL TEST BY: CERT. \O. D,�"I'E <br />CALIBRATIO�i DATE i 1-25-2014 GAUG�: # 030�0953 �IODEL !�lidwest 8-15 SERVICE RESI�ORED YES � NO <br />I certify that this report is accurate, and I have used 6VAC ?46-290-490 appro�ed test methods and test eyuipment. <br />