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AACRA Backflow Testing and Repair, �nc. BACKFLOW PREVENTIC?N ASSEMBLY TEST REPORT <br />(360) 668-1117 <br />WATER PURVEYOR Evei�ett <br />ASSEMBLY ID/FILE #/UTILITY DEV(CE # <br />NAME OF PREMISE The Towns <br />SERVICE ADDRESS 1 1217 19th Ave. SE <br />CONTACT PERSON Tannon Rocheloau <br />LOCATION OF ASSEMSLY North Side Center of Bldb. 1 <br />ACCOUNT# <br />Meter # 60608903 <br />Commercial ❑ Residential �❑ <br />_ Everett ZIP 98204 <br />PHONE (425) 766-0208 <br />DOWNSTREAM PROCESS Domeshc Water DCVA ❑� RPBA ❑ PVI3A ❑ OTHER <br />NEW INSTALL � EXISTING ❑ REPLACEMENT ❑ REMOVED ❑ OLD S�R.# <br />APPROVED ASSEMBLY? YGS I� NO ❑ PROPER INSTALLATION? YES � NO ❑ <br />MAKE OF ASSF,MBLY Conbraco/Apollo MODGL DCLF4A sER�AL �vo. 660743 SIZE 2�� <br />INI'Y'IAL nCVA / RPBA DCVA / RPBA RPBA PVRA / SV13A <br />CHECK VALVE N01 CHGCK VALVE N0.2 AIR INLET <br />TEST OPENED AT PSID <br />CLOSED TIGHT 0 CLOSED TIGHT ❑d OPENED AT psjD <br />PASSED 0 LEAKED ❑ LEAKED � #i CHECK PSID <br />FAILED � Z.2 ps� 2.6 PSID AIR GAP OK? DID NOT OPEN � <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />��w n n � -____..�______._. ��� <br />.------ � '� -_ <br />_. � ------------- HELD AT <br />PARTS ❑ ❑ C� ❑ U U LEAKED � <br />❑ ❑ ❑ ❑ ❑ ❑ <br />AND � � � � � � CLEANED <br />❑ <br />REPAIRS REPAIRED � <br />TEST AFTER CLOSED TiCHT ❑ CLOSED TIGHT ❑ RV EXERCISED ❑ AIR INLET PSID <br />KEPAIRS <br />LEAKED ❑ LEAKED ❑ orFNEn AT PSID <br />PASSED � <br />FAILED (� PSID PSID #1 CHGCK PSID CHK VALVE PSID <br />AIR GAP INSP�CTION: SUPPLY PIPE DIAMETER SEPARATION PASS � FAIL � <br />DETECTOR METER READING <br />LEFT SERVICE AS FOUND Isolation valve: Open d❑ Closed ❑ SOV#l: Open � Closed ❑ SOV#2: Open � Closed ❑ <br />REMARKS: <br />L[1�tE PRESSURE 99 PSI CONFIN�D SPACE? NO <br />TESTERS SIGNATURE: ����� CERT. No. B5601 DATE 4/20/2016 <br />T�STERS NAMG PRINTED Gary L. Srown TGSTERS PHONE #(360)668-1117 <br />REPAIRED I3Y: LIC NO. DATE <br />FINAL TEST BY: <br />GRT. NO. <br />DATE <br />CALIBRATION DATE 12-04-2015 GAUCE # 03050953 MODEL Midwest 845 SERVICE RESTORED YES 0 NO ❑ <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test �nethods and test equipment. <br />��% <br />J <br />