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BACKFLOW ASSEMBLY TEST REPORT <br />6ATman Testinci,F, <br />BACKFLOW ASSEMBLY TESTING AND REPAIR <br />DISTOMEA I FAQIEIY NAME <br />IDNPACT I Ut NINE <br />WATER MRVErOR <br />The Reserve at Everett LIH <br />EVERETT PUBLIC WORKS <br />NEW (YAYSTRURION ASSEMBLY l D6TONFA 10l <br />PNME MIMm FAY NUMSER <br />PURVEYOR C"AR NAME <br />®Y ❑N <br />- <br />Tim Markham <br />SERVIEE AOOA rR< I METER NUMBER <br />(15rOME0./ONHFA/fAMAR MAIUNG ADDAER <br />FV4VFYOR FAY NUNBOt <br />8920 Everareen Way <br />425 257-8882 <br />RTISTATE <br />.1OXE <br />IDTISTATE <br />TIPnAIE <br />NJRlEYOREMAILADD0.ES5 <br />Everett WA <br />I 98208- <br />tmarkham@evercttwa.gov <br />ASSEMBLY MANUFA(TRIER <br />MOOD. <br />SEIUU NUNBFA <br />TYPE <br />Siff <br />OOWHSIIITMIPP0655 <br />AMES <br />COLT 300-BF <br />OH-3100 <br />DCDA <br />4" <br />FIRE SPRINKLER SYSTEM <br />IDEAnON (F ASSEMBLY <br />Riser room at NE corner of building <br />wNnNEU SPACE <br />[]YES ENO <br />IHSTAUATION TYPE PREVIWS MAID: / MDDEL / SEEE I SDUAL NUMBER OETFR00. 0.FAO <br />E New [:]Existing []Replacement N/A <br />I <br />DON AI'PNOVED aLSENRtr ISEP<EBU IJST) <br />E YES ❑ NO <br />DxIENrAnox <br />H <br />vRpFER ENsrAlunox <br />® YES ❑ NO <br />WATER UNE PPESNIRE <br />80 PSHS <br />vuvE Favllaa wlaa TD rEmND <br />SOW I EON ❑OFF SOV42 EON DOFF <br />INITIAL TEST RESULTS <br />TEST AFTER REPAIRS/CLEANING <br />CHECK VALVE#I CLOSED TIGHT ❑ <br />CHECK VALVE#1 CLOSED TIGHT ❑ <br />LEAKED ❑ <br />LEAKED ❑ <br />RELIEF VALVE OPENED AT PSID <br />RELIEF VALVE OPENED AT PSID <br />FAILED TO OPEN ❑ <br />FAILED TO OPEN ❑ <br />CHECK VALVE#2 CLOSED TIGHT ❑ <br />CHECK VALVE#2 CLOSED TIGHT ❑ <br />RPBA <br />LEAKED ❑ <br />LEAKED ❑ <br />ACTUAL PRESSURE DROP <br />PSID <br />ACTUAL PRESSURE DROP PSID <br />ACROSS CHECK VALVE#1 <br />ACROSS CHECK VALVE #I <br />PASSED TEST ❑YES ONO <br />PASSED TEST ❑YES ONO <br />CLEAN / REPAIR: [:]see remarks <br />APPROVED AIR GAP []YES []NO <br />APPROVED AIR GAP ❑YES ONO <br />CHECKVALVE#I CLOSED TIGHT 3.7 PSID <br />CHECK VALVE #I CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />DCVA <br />CHECK VALVE#2 CLOSED TIGIrr 3.4 PSID <br />CHECK VALVE#2 CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED Cl <br />PASSED TEST EYES ❑NO <br />PASSED TEST ❑YES ❑NO <br />CLEAN / REPAIR: ❑ see remarks <br />IUIINILS <br />VALVE PO$TIOHS AnD11TSrIHG <br />SOV#1 EON ❑OFF SOV#2 EON ❑OFF <br />TESTER HAKE <br />MTQInION <br />TEST fWA'i MME <br />L4IGE MO(YL <br />TEST GAUGE SPRLL NUMBER <br />EAIIOE UIIOPAilO10ArE <br />Jason A. Moe <br />B4536 <br />Mid -West <br />845-5 <br />03051790 <br />01/08/2015 <br />REPADUD" <br />W PNIY NAME <br />(NONE NUMBER <br />N/A <br />- <br />nNALTESIBr <br />MTIERnncAnoN <br />TEST6WGT V <br />G EMODEL <br />E PANY WE <br />NONE NUMBER <br />N/A <br />BATman Testing <br />206 228-1618 <br />mu w nNu T <br />05/13/2015 <br />I HEREBY CERTIFY THAT I USED WPC 24f-290490 APPROVED, USC 10- Edrdon TEST METHODS AND DIFFERENTIAL PRESSURE TEST EQUIPMENT FOR THE ABOVE TEST RESULTS <br />�aj <br />