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c_.__--__.� <br />t:: �� AACRA Backflow Testing and Repair, �nc. ��GEC�Ld)W �'����E�TIO�d ASSEM��Y TESi REPQO�,�' <br />, ,��.; -s <br />� -7*'^-"`.i--� (360) 668-1117 <br />WATER PURVEYOR Silver Lake ACCOUNT # <br />ASSEMBLY ID/FILE #/UTILITY DEVICE # Meter # 60599853 <br />NAME OF PREMISE The TOwns Commercial i] Residential � <br />SERVICE ADDRESS 1 1217 l9th Ave. SE Everett <br />ZIP 98204 <br />CONTaCT PERSON Tannon Rocheloau PHONE (4?5) 766-0208 <br />LOCATION OF ASSERIBLY SW Corner of Bld�. 6 <br />DOWNSTREAivI PROCESS Domestic Water DCVA �,il RPBA ��; PVSA _' OTHER <br />NEW INSTALL ,�1 EXISTING REPL.ACEMENT �__ REMOVED i_.I OLD SER.# <br />APPROVED .4SSEh1BLY? YES � NO `_ PROPER INSTALLATION? YES i✓j NO '' <br />MAI:E OF ASSEME3LY Conbraco/Apollo �70DEL DCLF4A SERIAL N0. 636680 SIZE 1.5�� <br />INITIAL DCVA / RPBA DCVA / RPBA RPBA PVBA / SVSA '; <br />TEST CHECK VALVE NO.1 CHECK VALVE N0.2 AIR INLET '�' <br />oPE�vEu,a�r PSID �i <br />CLOSED TIGHT '�!' CLOSED TIGHT i_�' OPENED AT <br />PSID � <br />PASSED ;,ri LEAKED _-' LEAKED -. #1 CHGCK PSID <br />FAILED ;; 1.6 PSID 1�6 PSID <br />AIR GAP OK? DID NOT OPEN [� <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW _1 !_, _ _ `j L) HELDAT <br />__ _ � PSID <br />PARTS i_] ; � _ <br />-- ___: _ LEAKED � <br />AND ;� i_-i _ ' __ .__' ❑ <br />�, �_� ,- - <br />- - — ;_I CLEANED J <br />REPAIRS <br />uEY.a�uH.n <br />TGST;�F'TER CLOSED TIGHT � CLOSED TIGHT �_� RV EXERCISED [' <br />REP.a1RS __ AIR INLET PSID <br />LEAKED '_, LEAKED '-� pPE��Eu ,�7' PS[D <br />PASSED r-� <br />FAILED `_j PSID PSID #t C»ECK PSID C}IK b:ALVF; PS1D <br />AIR GAP INSPECT[ON_ SUPPLY PIPE DIA��IETER SEPARATION <br />llG'I�EC7'O!t NIETEFi IZL;ADING � <br />LEFT SERVICE .AS FOUND �solation ���he: Open � Closed _—' SOV#I Open j�l Closed �—; <br />REn9�RKS: <br />TESTERS SIGNATLIRE: ����� <br />TESTERS NAME PRINTED Gary L. Brown <br />REP.AIRED BY: <br />FINAL TEST BY: <br />PASS�j FAIL(� <br />SOV#2: O�en 0 Ctosed '. <br />�� : <br />�; - <br />- LINE PRESSURE g6 PSI CONFINED SPACE? NO <br />CERT. NO. B5601 DATE 5/30/20't5 <br />TESTERSPHONE# _�3C)O)66H-'I'I'I% <br />LIC NO. DATE <br />ERT. NO. <br />DATE <br />CALIBRt1TION DATE 11-2�-201� GAUGE # 030�09�3 �90DEL Midwest 845 SERVICE RESTOREll YES [j NO � <br />I certify thaE this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. <br />