2009 113TH PL SE 2017-01-18 - Laserfiche WebLink

AACRA Backflow Testing and Repair, �nc. BACKFLOW PREVENTION ASSEMBLY TEST REPORT � . (360)668-1117 WATER PURVEYOR Everett ACCOUNT # ASSEMBLY ID/FILE #NTILITY DEVICE # Meter # 60937064 NAME OF PREMISE The Towns SERVICE ADDRESS 11217 19th Ave. SE Commercial ❑ Residential � Everett ZIP 98204 CONTACT PERSON Tannon Rocheloau PHONE (425) 766-0208 LOCATION OF ASSEMBLY SE Corner Bldg 4 DOWNSTREAM PROCESS Domestic Water DCVA ❑� RPBA ❑ PVBA ❑ OTHER NEW INSTALL ❑d EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES ❑�/ NO ❑ PROPER iNSTALLATION? YES ❑� NO ❑ MAKE OF ASSEMBLY Conbraco/Apollo MODEL DCLF4A SERIAL NQ. 66834g SIZE 1.5�� DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA INITIAL �„N��i� V�� ,� Ni).1 �,�11�C'� �IA�V1F Nn.2 AIR INLET 'TES'I' OYEIVED A7' I'SIY9 ' CLOSED TIGHT � 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 REPIACE PART CLEAN REPLACE PART CHECK VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ � � � LEAKED ❑ ❑ ❑ ❑ � ❑ ❑ A� � � � � � � CLEANED ❑ REPAIRS REPAIRED � TEST AFTER CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET PSID REPAIRS LEAKED ❑ LEAKED ❑ OPENED AT PSID PASSED � PSID pSID #1 CHECK PSID CHK VALVE PSID FAILED � AIR GAP INSPECTION: SUPPLY P1PE 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: �%��J CERT. NO. B5601 DATE 4/20/2016 TESTERS NAME PRINTED Gary L. Brown TESTERS PHONE #(360)668-1117 REPAIRED BY: FINAL TEST BY: LIC 1Y0. CERT. NO. DATE DATE CALIBRATION DATE 12-04-2015 GAUGE # 03050953 MODEL Midwest 845 SERVICE RESTORED YES � NO ❑ I certify that this report is accurate, and I have used WAC 24b-290-490 approved test methods and test equipment. r/ � 0��