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AACRA Backflow Testing and Repair, ��c. BA�KFLOW PREVENTION ASSEMBLY TEST REPORT <br />(3S0) 668-1117 <br />WATER PURVEYOR Everett <br />ASSEMBLY ID/FILE #/UTILITY DEVICG # <br />NAME OF PREM�SE The Towns <br />SERVICE ADDRESS 11217 19th Ave. SE <br />COIVTACT PERSON Tannon Rocheloau <br />LOCAT[ON OF ASSFMBLY North Side Center of Bldg. 1 <br />ACCOUNT # <br />Meter # 60608903 <br />Commercial ❑ Residential � <br />_ Everett ZIP 98204 <br />PHONE (425) 766-0208 <br />DOWNSTREAM PROCESS Doinestic Water DCVA ❑� RPBA ❑ PVBA ❑ OTHER <br />N�W INSTALL � GXISTING ❑ RF,PLACGMGNT ❑ REMOVED ❑ OLD SER.# <br />APPROVED ASSF.MBLY? YGS � NO ❑ PROPER INSTALLATION? YES [J (�O ❑ <br />MAKE OF ASSEMBLY Conbraco/Apollo MODGL DCLP4A SGRIAL NO. 660743 SIZ� 2�� <br />YNI"TIAL DCVA / RPRA DCVA / RPBA RPBA PVBA / SVBA <br />CHECK VALVE NO.1 CHECK VALVE N0.2 AIR INLET <br />TEST OPENED AT PSID <br />CLOSED TIGHT � CLOSED TIGHT � OPENED AT pSjD <br />PASSED � LEAKED ❑ LEAKED � #1 CHECK ps� <br />FAILED � 2.2 PSID 2•� PSID <br />AIR GAP OK? DID NOT OPEN ❑ <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />NEW CJ �1 _ _. ------ �1 Cl f� HEI�n A'C __.._ ___.____ _ _. �S� <br />------_ � ---------- <br />PARTS L� ❑ ❑ ❑ � U LEAKED � <br />AND � � � � � � <br />❑ ❑ ❑ ❑ ❑ ❑ CLEANED � <br />REPAIRS REPAIRED <br />❑ <br />TEST A�TGR CLOSED TIGHT ❑ CLOSED TIGHT ❑ RV GXERCISED ❑ AIR INLET ps� <br />REPAIRS LEAKI:D ❑ LEAKEll ❑ OPENED AT <br />PSID <br />PASSED � <br />FAILED � PSID PSID #t CxECK PSID CHK VALVE PSID <br />AIR GAP INSPECTION: SUPPLY PIPE DIAMETER SEPARATION <br />DETECTOR METER READING <br />LEFT SERV[CE AS FOUND Isolation valve: Open 0 Closed ❑ SOV#1: Open � Closed ❑ <br />REMARKS: <br />TESTERS SIGNATURE: �x��� <br />TESTERS NAM� PRINTED Gary L. Brown <br />REPAIRED BY: <br />FINAL TGST BY: <br />PASS � FAIL � <br />SOV#2: Open ❑�/ Closed ❑ <br />- LINE PRESSURE 99 PSI CONFINED SPACE? No <br />CERT. NO. g5601 DATE 4/20/2016 <br />TESTERS PHONE # (360)668-1117 <br />LIC NO. DATE <br />CERT. NO. <br />DATE <br />CALIBRATION UATE 12-04-2015 C:AUCG # 03050953 MODGL Midwest 845 SERVICE RESTORED YES ❑�/ NO ❑ <br />I certify that this report is accurate, and I liave used WAC 246-290-490 approved test methods and test equipment. �� <br />