2019 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 # 60608907 NAME OF PREMISE The Towns SERVICE ADDRESS 11217 19th Ave. SE Commercial ❑ Residential � Everett ZIP 98204 CONTACT PERSON Tannon Rocheloau PHOfVE (425) 766-0208 LOCATION OF ASSEMBLY SW Corner Bldg 2 DOWNSTREAM PROCESS Domestic Water DCVA ❑� RPBA ❑ PVBA ❑ OTHER NEW INSTALL ❑� EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD SER.# APPROVED ASSEMBLY? YES L� NO ❑ PROPER INSTALLATION? YES 0 NO ❑ MAKF, nF ASSFMSLY Conbraco/Apollo MODEL DCLF4A SERIAL NO. 6gg224 S1ZE 2�� DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA INITIAL CHECK VALVE NO.1 CHECK VALVE N0.2 AiR I1�TLET TEST OPENED AT PSID CLOSED TIGHT 0 CLOSED TIGHT � OPENED AT PSID PASSED � #1 CHECK PSID LEAKED ❑ LEAKED ❑ DID NOT OPEN ❑ FAILED � 1.9 ps� 1 g PS� AIR GAP OK? CLEAN RFPLACE PART CLEAN RFPLACE PART CLEAN REPLACE PART CkIECTC VALVE NEW ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID PARTS ❑ ❑ ❑ � � � LEAKED ❑ ❑ ❑ ❑ ❑ ❑ ❑ AND � � � � � � 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 �'AIlL�I9 � AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION r�►�s U raiL U DETECTOR METER READING LEFT SERVICE AS FOUND Isolation valve: Open 0 Closed ❑ SOV#1: Open � Closed ❑ SOV#2: Open 0 Closed ❑ REMARKS: LINE PRESSURE 90 PSI CONFINED SPACE? No TESTERS SIGNATURE: �%�� CERT. NO. 85601 DATE 4/20/2016 TESTERS NAME PRINTED Gary L. Brown TESTERS PHONE #(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 ❑�/ NO ❑ I certify that this repc�rE is accurafe, and I have used 6!'AC 296-290�90 ayproved test methods and test equipment. ��