2001 113TH PL SE 2017-01-13 - Laserfiche WebLink

AACRA Backfiow Testing and Repair, �nc. BACKFLOW PREVENTI()N ASSEMBLY TEST REPORT _ (360) 668-1117 WATER PURVEYOR Everett ACCOUNT ASSEMBLY ID/FILE #/UTILITY DEVICE # Meter # 60937064 NAME OF PREMISE The Towns Commercial ❑ Residential 0 SERVICE ADDRESS 11217 19th Ave. SE Everett ZIP 98204 CONTACT PERSON Tannon Rocheloau PHONE (425) 766-0208 LOCATION OF ASS�MBLY SE Corner Bldg 4 DOWNSTREAM PROCESS Domestic Water DCVA � RPBA ❑ PVBA ❑ OTHER NEW INSTALL [� EXISTING ❑ REPLACCMENT ❑ RGMOV�ll ❑ OLD SER.# APPROVED ASS�MBLY? YES �/❑ NO ❑ PROPER INSTALLATION? YES � NO ❑ MAKE OF ASSEMBLY Conbraco/Apollo MODEL DCLF4n SERIAL NO. 668348 SIZE 1.5" DCVA/RPBA UCVA/RPBA RPBA PVBA/SVBA INITIAL AIR INLET TEST CHECK VALVE NO.I CHECK VALVE N0.2 OPENED AT ps� CLOSED TIGHT �/❑ CLOSED TIGHT � OPENED AT PSID PASSED � LEAKED ❑ LEAKED � #1 CHECK PSID FAILED � 2.2 PSID 2• 1 PSID AIR GAP OK? DiD NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT ps� PARTS L� C� L� L� n C� LEAKEll (_f ❑ ❑ ❑ ❑ ❑ ❑ AND � � � � � � CLEANED ❑ REPAIRS REPAIRED ❑ TEST ArTER CLOS�D TIGHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ �IR INLET psrp REPAIRS LEAKED U L�AKED ❑ OPENED AT PSID �� 1��1-:1) [J _.____ �._ FAILED � Ps� PSID �1 CHLCK PSID CHK VALVE P�� AIR GAP INSPECTION: SUPPLY PIPE DIAMETER DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open 0 Closed ❑ SOV#1 REMARKS: SEPARATION PASS � FAIL � Open ❑o/ Closed ❑ SOV#2: Open ❑�/ Closed ❑ LI1�E PRESSURE 91 PSI CONFINED SPACE? No TESTERS SIGNATURE: �%�� CERT. NO. 85601 DATE 4/20/2016 TESTERS NAME NRINTED Gary L. Brown TESTERS PHONE #(360)668-1117 REPAIRED SY: L[C NO. DATE FWAL TEST BY: ___ CERT. NO. DATE CALIBRATION DATG 12-04-2015 GAUGE # 03050953 MODEL Midwest 845 SERVICE RESTORED YES [J NO ❑ I certify that this report is accurate, and I have used WAC 246-290-490 approved test inethods and test equipment.