2003 113TH PL SE 2017-01-13 - Laserfiche WebLink

AACRA Backflow Testing and Repair, �nc. BACKFLOW PREVENTION 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 ASSEMBLY SE Corner Bldg 4 DOWNSTREAM PROCESS Domestic Water DCVA [J RPBA ❑ PVBA ❑ OTHER NEW INSTALL � EXISTING U REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSGMBI.Y? YES C� NO ❑ PROPER IIYSTALLATION? YES �] NO ❑ MAKF, OF ASSEMBLY Conbraco/Apollo MODGL �CI.F�� SF.RIAL NO. 668348 SIZE 1.5" INITIAL DCVA / RPf3A DCVA / RPBA RPBA PVBA / SVBA CHF.CK VALVE NO.I CHECK VALVE N0.2 AIR II�iLET TEST OPENE� A'r PSID CLOSED TIGHT L� CLOSED TIGHT [� OPENED AT PSID PASSED � LEAKED ❑ LEAKED � #1 CHECK�____�SID FAILED � 2.2 PSID 2•1 PSID AIR GAP OIi? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE N�W ❑ ❑ ❑ ❑ ❑ ❑ HELD AT psjD PARTS ❑ ❑ ❑ ❑ � � LEAKED ❑ AND � � � � � � ❑ ❑ ❑ LJ L] �] CLEANED ❑ REPAIRS � REPAIRED TEST AFTER CLOSED TIGHT ❑ CLOSED TIG}IT J RV EXF,RCISED U AIR I(�LET PSID REPAIRS LEAKED ❑ LCAKEll ❑ OPENED AT PSID PA5SED � FAILED � �'�ID PSID #1 CHEC,K PSID CHK VALVE PSID AIR GAP INSPECTION: SUPPLY PIPE DIAMETER �EPARATION DETECTOR METER READING LEFT SERVICE AS FOUND �solation valve: Open ❑�/ Closed ❑ SOV#1: Open ❑�/ Closed ❑ l2EMARKS: PASS [] FAIL � SOV#2: Open � Closed ❑ LINE PRESSURE 91 PSI CONFINED SPACE? NO TESTERS SIGNATURE: �%�� CERT. NO. B5601 DATE 4/20/2016 TESTERS lYAME PRINTED Gar,y L. Brown TESTGRS PHONE #(360)668-1117 REPAIRED BY: LIC NO. DATF. FINAL TF.ST BY: CERT. NO. DATG CALIBRAT[ON DATG 12-04-2015 GAUGE # 03050953 MODEI. Midwest 8�5 SERVIC[: RCSTORED YES 0 NO ❑ I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.