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;` t;� AACRA Backflow Testing and Repair, �nc. �ACKFLOW P�iEVENT10Idl ASSEMBLY TEST REPORT <br />�"''� T (360) 668-1117 <br />W.4TGR PURVEYOR Silver Lake ACCOUNT# <br />ASSENIBLY ID/FILE #/UTILITY DEVICE # Meter # 60599847 <br />NAME OF PREIbIISE The TOwttS Commercial [ i Residential [�] <br />SERVICE ADDRESS 1 1217 19th Ave. SE Everett ZIP 98204 <br />CONTACT PERSON Tannon ROcheloau PHOi�E (425) 766-0208 <br />LOCATION OF ASSEMBLY E. Side of Bida. 5 <br />DOWNSTREAM PROCESS Domestic Water nCv.A �; RPBA '' PV13A [.__; OTHER <br />NEW INSTALL L�! EXIST(NG L' REPL.ACEMEN"i' '._. REMOVED CI OLDSER.# <br />APPROVED ASSEMBLY? YES C�J NO U PROPER INSTALLATION? YES !di NO `...' <br />NIAKE OF ASSEMBLY Conbraco/Apollo n-�op��, DCI,F4A SERIAL NO. 634808 S[ZE 2�� <br />INITIAL DCVA / RPBA DCVA ! RPBA RPSA PVBA / SVBA <br />CHECK VALVE NO.1 CHECK V.ALVE N0.2 AIR INLET <br />TEST opcvED :�T pSID <br />CLOSED TICHT ✓i CLOSED TIGHT ;.i; OPENED AT PSID <br />PASSED ��,: LEAKED C.i LEAKED - #t CHECK PSID <br />FAILED ;�; 1.6 PSID � •6 PSID <br />.aIR GAP OK? DID NOT OPEN ❑ <br />CLEAN REPIACE PART CLEAN REPLACE PART CLEAN REPIACE PART CHF,CK VALVE <br />NEW i-; �`] i_ -_ _- ;__' xr.�n aT PSID <br />PARTS L� �- _ — -- LEAKF,D ❑ <br />! J �_ .., . '—; <br />AND � ...., __ <br />� � , `_ __. — __ CLG:�:�F,D ; ; <br />REPAIRS <br />REP,4IRED r, <br />TEST AFTER CLOSED TICHT i CLOSED T1GHT _ R�' EXERCISED �. ,UR I\LET PSID <br />REP �IRS _ <br />LEAKED I_._i LEAKED _.. oYE�[:�;�T PSID <br />PASSED �_J - <br />FAILED � PSID PSID #� c�Hh;�h PSMD �Hh v:at.vE PSID <br />��IRGAP INSYECrIUN: SUPPLY� t�IPE UTAiiIE�CE12 S1:I'AR.A�fION <br />DETECTOR METER RE.4DING <br />LEFT SERVICE AS FOUND �solation valvr. Open ,i Closed :_ SOV#1 Open ;� Closed ;_-, <br />i':�SS,' F�:UL� �� <br />SOV#2: Open �' Closed I_j <br />RENIARKS: <br />x: : <br />LINE PRESSURE �5 PSI CONFINED SPACE? NO <br />;:�:,� <br />TESTERS SIGN.4TURE: �x��� CERi'. :�`O. B5601 DATE 5/3Q12015 :`' i <br />TESTERS NAME PRINTED Gary L. Srown TESTERS PHOIVE #(360)668-1117 <br />REPAIRED BY: LIC NO. DATE <br />FINAL TEST BY: CERT. NO. UATE <br />CALIBRATION DATE 11-25-2014 GAL'CE # 030�09�3 NiODEL Nlidwest 845 SERVICE RES7'ORED YES '.ii NO r. <br />I certify that this report is accurate, and I have tised WAC 246-290-490 approced test methods and test equipment. <br />-.._. <br />