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BACKFLOW PREVENTIO ASSEMBLY TEST ^ ����� <br /> P cco��� <br /> WATERPORVEYOR e � a U f� ���� y �� <br /> 11tNer p <br /> ASSEAtBLYlD/EILEA/UT1L17'YDEYICENlID l� ������T„�, <br /> ik11�_ <br /> NM1E OF PREMTSE L <br /> SERVICEADDRFSS �.� �� D4 �VG CI . ���� -� z� 9�,aor <br /> PHONE�!�!J-` 3S' �G��F <br /> CO�?ACf PERSOT 2 r �^ ' �'N <br /> LOCATION OFASSE�IBLY ���� T���� �`� -� � 'l+ �� � �� <br /> r <br /> .v S i�pi� / ✓I �0 r I f� DCVA O 1'iP BA'� PVSA O OTIIER <br /> D O WNSTRE ADt PROCESS� <br /> NEH'INS7'ALLJ�LEXISTINGO REPLACEDIBNT� OLDSERA <br /> \1:�SW NGTON SYATE MPR� ASSEIIIBLY?YFS�NO O PROPER IHST.ILGATION?YF���� <br /> u� �j���(t/� / <br /> � � !V y 10DEL=1 "�SERIAL\O. �'J 5 ' { 5¢E ' <br /> MAKE OF ASSEI�iBLY . <br /> DCVAlRPBA DCVAlRPCA $�@A PYBAICVRA <br /> CHFCK VALVE NO.1 !'RF.i7K VALVE N0.2 �( AIRPI[-ET <br /> T ST L OPENED AT�'=o SID oP�ED AT PSID <br /> LEAKED ❑ LEAI:ED �Ge I.o <br /> CLOSF,D T:GHT� CLOSED TIGHT� Nl CNL•CK,�PS�D DID NOT OPEN � <br /> PASSED pglp PSID {�R GAP OK? � PS CFiECK VALVF <br /> FAI[,E� � Mi�I.0 Min i.o <br /> ttFw� avucE r�wr �tEt� a .�� w nm.u-E �Mr IIELD AT PS1D <br /> O O � � ���� �tro t.o <br /> NEW 0 � ❑ ❑ RVDix LEAKED � <br /> r�x�rs ❑ ❑ ❑ ❑ p p - <br /> "�`n ❑ ❑ � � o ❑ CLEADIEU ❑ <br /> REPAIRS ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ R[PAIRED 0 <br /> Ecc+cixdReliefValve ❑ <br /> TESTAFfER LEAKED ❑ LEAKED � pp�D AT_PSID ,uR IDILET PSID <br /> RElAIRS CLOSED TIGHT � CLOSCD TIGNT O M;n:.o um i.o <br /> PASSED ❑ PSID ps� Ml CHL•CK PSID c;Hti VALVG PSID <br /> FAII.ED❑ Alin 1.0 Min 1.0 Min 1.0 <br /> AIR CAP I[�SPECTION:Su�yAyPit�e oi+m�i�r. �Scpantioe: Pess O Fail O AHMar�Icter Readln6 �, ' ' — <br /> RE\tARFCS: UWJ L� S[ f� �j t:ONr -fr�� lP5� 7"/9lP�.u/rj Drrt /IVf �Uh�A�.'' <br /> LI�E PRESSURE�S PSI C NF4�1 D.SYACEY�L <br /> TESTER'S 5IGNATUItE: CERT.NO.B4203 DATE T.P 3 �U �/ <br /> TESTER'S NAD1E PRINYED:Ron Bro�cn TESTER'S PHONE A���1-��6-8019 (4251821-6801 <br /> REPAIRED BY: DATE <br /> FINAL TEST BY: CERT.NO. DATE <br /> (:aLIeRATION DATE /� �L��� GAUGE M 0208240811Iid-WCSt 845-5 <br /> CAL.IBRATIOh DATE�a i' �D CAUGE N Sl Prime 146 � SERV[CE RESTORED� YES � NO ❑ <br /> LEFT SERVICE AS FOUND-.�ldnrlliol�U�n ral.r. O�❑ Cbsed � SOYNI:Open❑ Cbud ❑ SOVNI:Opn 0 Cbsed � <br /> !tnril7 d�.10 nNtf6 wvn+ir.�w/!i�or!R:ICTlF:9HH M?�^��al�er4✓+r!/t�+H��K <br /> R A Brow'n Dac1�11aw Tcsting rabrownWt(u�,yahou•cum Ron Brown <br /> 14213 95�h AVE NE 13ackflow Specialry Plumbe Licenu k Hon�dCu:22o56-�Z�6-�9 <br /> 8othell,\YA 98011-5152 BRO�ti'NR'95AB8 <br />