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AACRA Backflow Testing and Repair, �nc. BAC+KFLOW PREVENTION ASSEMBLY 7EST REPOi2T <br />(360) 568-1117 <br />WATER PURVEYOR Everett <br />ACCOUNT <br />ASSEME�LY ID/FILE #/UTiLITY DEVICE # Meter # 60608903 <br />NAME GF PREMISE The Towns Commercial ❑ Residential � <br />SERVICE ADDRESS 11217 19th Ave. SE Everett zip 98204 <br />CONTACT PERSON Tannon Rocheloau PHONE (425) 766-0208 <br />LOCATION OF ASSEMBLY North Side Center of Bldg. 1 <br />DOWNSTREAM PROCESS Doinestic Water DCVA [� RPBA ❑ PVBA ❑ OTHER <br />NEW 1NSTALL � EXISTING ❑ REPLACEMGNT ❑ RI;MOVED ❑ OLD SGR.# <br />APPROW�D ASSEMBLY? Y�S I�l NO Cl PROPrR [NSTALLATION? YES n lv0 ❑ <br />MAKE OF ASSEMBLY Conbraco/Apollo MODGL �CLF4� sERtAL No. 660743 SIZE 2�� <br />��I,�,�� DCVA / RPI3A DCVA / RP[3A RPBA PVBA / SVBA <br />CHECK VALVE NO.I CHECK VALVF N0.2 AIR INLET <br />TE�T OPENED AT PSID <br />CLOSED TIGHT O CLOSED TIGHT ❑�/ OPENEll A'T psjj� <br />PASSED 0 #1 CHECK PSID <br />LEAKED ❑ LEAKED ❑ <br />FAILED � 2.2 pSID 2•� PSID <br />AIR CAP OK? DID NOT OPEN ❑ <br />CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE <br />IlTF`V CI I—I _ _-- --- n � --------- �-� I I ------- HF,LD AT _, . �'��D <br />_..�._____._--- ._ <br />P��T� � � � � u U LEAKED � <br />ANI) ❑ n ❑ ❑ ❑ ❑ <br />❑ ❑ ❑ ❑ ❑ ❑ CLEANED � <br />REP'AIRS � <br />REPAIRED <br />TEST AFTER CLOSED TICHT ❑ CLOSED TICHT ❑ RV EXERCISED ❑ AIR INLET ps� <br />REP'AIRS LEAKED ❑ LEAKED ❑ OPENED AT <br />PSID <br />PASSED � <br />FAIL�ED � PSID PSID #1 CHECK YSID CHK VALVE PSID <br />AIR GA.P INSPF.CTION: SUPPLY PIPE DIAMETER S�PARATION <br />DETECTOR MET�R READING <br />LEFT SERVICE AS FOUND lsolation vah�e: Open � Closed ❑ SOV#l: Open [� Closed ❑ <br />REMARKS: <br />TESTEI[tS SIGNATURE: �%x��� <br />T�STERS NAME PRINTED Gary L. Brown <br />ftEPAI1ftED BY: <br />FINAL TEST BY: <br />PASS � FAIL � <br />SOV#2: Open ❑r/ Closed ❑ <br />_ LINE PRESSURE 99 PSI CONFINED SPACE? No <br />CERT. NO. B5601 DATE 4/20/2016 <br />T�STERS PHONE # (360)668-1117 <br />LIC NO. DAT� <br />CERT. NO. <br />IIJ:yY� <br />CALIBRATION DATE 12-04-2015 GAUCE # 03050953 MOD�L Midwest S45 SERVICE RESTORED YES � NO ❑ <br />I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment. � <br />