2007 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 # NAME OF PREMISE The Towns SERVICE ADDRESS 11217 19th Ave. SE CONTACT PERSON Tannon Rocheloau Meter # 60937064 Commercial ❑ Residential ❑d Everett zIP 98204 PHONE (425) 766-0208 LOCATION OF ASSEMBLY SE Corner Bldg 4 DOWNSTREAM PROCESS Domestic Water DCVA ❑� RPBA ❑ PVSA ❑ OTHER tVEW INSTALL � EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES � NO ❑ PROPER INSTALLATION? YES � NO ❑ MAKE OF ASSEMBLY Conbraco/Apollo MODEL DCLF4A sERIAL �vp. 668348_ s�zE 1.5" DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA INITIAL AIR INLET �i'!�'�� `J��Fl1F N().l C1-i'�CK ljAl� 111F. N0.2 T�ST � OYENIEID A'�' i'S� CLOSED TICHT � CLOSED TIGHT � OPENED AT PSID PASSED � LEAKED ❑ LEAKED � #1 CHECK PSID FAILED � 2.2 ps� 2.1 PSID AIR GAP OK? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ � � � LEAKED ❑ ❑ ❑ ❑ ❑ ❑ ❑ A� � � � � � � CLEANED ❑ REPAIRS REPAIRED ❑ TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV E)CERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ I.EAKED ❑ OPENED AT PSID PASSED � PSID PSID #1 CHECK PSID CHK VALVE PSID FAII.ED � AIR GAP INSPECTION: SUPPLY PIPE DIAM ETER SEPARATION PASS � FAIL � DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open � Closed ❑ SOV#1: Open � Closed ❑ SOV#2: Open � Closed ❑ REMARKS: LINE PRESSURE 91 PSI CONFINED SPACE? No TESTERS SIGNATURE: b,x�� CERT. NO. B5601 DATE 4/20/2016 TESTERS NAME PRINTED Gary L. Brown TESTERS PHOIVE #(360)668-1117 REPAIRED BY: LIC NO. DATE FINAL TEST BY: CERT. NO. DATE CALIBRATION DATE 12-04-2015 GAUGE # 03050953 MODEL Midwest 845 SERVICE RESTORED YES 0 NO ❑ I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.