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��:.: <br />}:': �� AACRA Backflow Testing and Repair, �nc. BACKFLC)W P�EVENTIORII ASSEMBLI( TEST REPORT <br />y..::�r� <br />�--+r''�-�'tit--1 (360) 668-1117 <br />WATER PURVEYOR _Silver Lake ACCOUNT# <br />ASSEN9BLY ID/FILE #/UTILITY DEVICE # Meter # 605998��7 <br />NAME OF PREMISE T}le TownS Commercial ['; R.esidential � <br />SERVICE ADDRESS ] 1217 19th Ave. SE Everett Z�p 98204 <br />CONTACT PFRSOn Tannon Rocheloau pHn;�E (425) 766-0208 <br />LOCAT[ON OF ASSEMBLY_ E. Side of Blda. 5 <br />DOWNSTREAM PROCESS Domestic Water �Cv,a ;�: RPBA i. j PVBA �_ ;. OTHER <br />NEW INSTALL ��i EXISTING Ll' REPLACEMENT REMOVED �_I OLD SER.# <br />APPROVED ASSEMBLY? YES i� NO �� PROPER INSTALLAT[ON? YES !di NO !_' <br />MAKE OF ASSEMBLY Conbraco/Apollo ,1-IODGL DCLF4A SERI,a� No. 634808 SIZE 2�� <br />INITIAL DCVA / RPBA DCVA ! RPBA RPBA I'VBA / SVBA <br />CHECK VALVE NO.1 CHECK VALVE N0.2 AIR INLET <br />TEST oPEVEn :��r PSID <br />CLOSED TIGHT ✓� CLOSED 7-IGHT �; OpEtiF;D AT PSID <br />PASSED �:. LEAKED Ci LEAKED _- #t CI�ECK PSID <br />FAILED � I .6 pSID � •6 PSID <br />AIR GAP OK? DID NOT OPEN ❑ <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW j_ �' I`� __ '_ _ _ ,– HELC► AT PSID <br />PARTS — ' —, ;-- -- _ -- <br />� ;� � _ LEAH:ED I i <br />AND ;- i� _ - —, — �- <br />� _; - <br />, `_, _._ _ CLG:rtiF,D � <br />_. � ' � <br />REPAIRS — -- <br />RGP��IRED ;_ <br />TEST AFT[?R CLOSED TIGHT ;�I CLOSED TIGHT RV EXERCISED � ,��R I�LGT PSID <br />REPAIRS __ <br />LEAKED '-� LEAKED OPE�ED;�T PSID <br />PASSED �-; <br />FAILED �__ PS[D PS[D #1 Ct►ECh PS1D LHk: �',�L�'E PS1D <br />A{12GAP IN�f'ECf IU\: SU�'N1,Y 1'IYE DIAi�1�;'I��:K SEPAIL�a"CCON <br />DETECTOR METER RE.4DING <br />LEFT SERVICE AS FOUND �solation �-alve: Open ;;� ('losed _ SOV#1 Open (.� Closed ;__, <br />P:�SS�. �� F:UL� � <br />SOV#2: Open [, Closed [j <br />REfViARICS: <br />LINE PRESSURE �5 PSI CONFINED SPACE? NO <br />�x.�,� ,� � <br />TESTERS S[CNATURE: CERT. :�`O. 85601 DATE 5/30/2015 <br />`.i <br />TESTERS NAME PRINTED Gary L. Brown TESTEFZS PIiOIVE #(360)668-1117 <br />REPAIRED BY: LiC NO. DA'TE <br />FINAL TEST BY: CERT. NO. DATE <br />CALIBRATION UATE 11-25-2014 GAUGE # 030�09�3 1�IODE1� Niidwest 845 SERV(CE RE!�"I'ORED YES i•!� NO ;. <br />I certify that this report is accurate, and I hace used 4VAC 246-290-490 approced test methods and test equipment. <br />r <br />