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BACKFLOW ASSEMBLY TEST REPORT <br />BATman Tgstin�w <br />BACKFLOW ASSEMBLY TESTING AND REPAIR <br />OI 01/FAUTTY NAME <br />Wx T/OWNUIMANE <br />WATER MIRNEYOR <br />EVERETT PUBLIC WORKS <br />The Reserve at Everett LIH <br />NEW CDNST0.11CrfON ASYHBIY/CVSroMEA IDI <br />PHONE NUMBER FA%MIMRFR <br />PURVEYOR mNTAET NAME <br />®Y ❑N <br />Tim Markham <br />$GNQ AOOR6Sl MEIFA NUMBER <br />p61DMG/OWNOI/DOYIAR NAILING AOORETS <br />PU4VEVDA FAX MIMRFA <br />8920 Ever een Wa <br />425 257-8882 <br />OTY/STAR <br />DP mDE <br />CTIY/STATE <br />DP moE <br />PURVEYOR EMAIL ADgMSS <br />Everett WA <br />98208- <br />tmarkham@everettwa.gov <br />ASSDLBLY MINU/AElU1ER <br />WILKINS <br />M <br />350ADA <br />SER4I NUMBFA <br />V41899 <br />TYPE <br />DCDA <br />soE <br />6" <br />DONNSIRFAY P4OQS5 <br />FIRE SPRINKLER SYSTEM <br />E ATICN OF EMBLY <br />[DNFENED yAO: <br />®NO <br />Riser room at NE comer of building❑YES <br />IN WAnm TYPE PRLVId15 NAEo:/MODEL/5�/sEREAL murex <br />ocncroR READ <br />N/A <br />® New ❑ Existing ❑ Replacement <br />OOHAWROYFD ASSEMBLYMPT2012UM <br />® YES ❑ NO <br />OMENTATI N <br />VII <br />I PRDP[R INSTAIIAUM <br />® YES [:]NO <br />WATER UNEPRESSIDIE <br />80 PSIG <br />VALVE POSmOHS PRIDR roTFSnNG <br />SOV#I ❑ON ®OFF SOV#2 ❑ON ®OFF <br />INITIAL TEST RESULTS <br />TEST AFTER REPAIRS/CLEANING <br />CHECK VALVE#I CLOSED TIGHT ❑ <br />CHECK VALVE#I 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 N2 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 />VALVE #I <br />ACROSS CHECK VALVE#1 <br />ACROSS CHECK <br />PASSED TEST []YES []NO <br />PASSED TEST ❑YES [:]NO <br />CLEAN / REPAIR: ❑ see remarks <br />APPROVED AIR GAP ❑YES❑NO <br />APPROVED AIR GAP ❑YES❑NO <br />CHECK VALVE#1 CLOSED TIGHT 2.8 PSID <br />CHECK VALVE I CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />DCVA <br />CHECK VALVE CLOSED TIGtrr 2.6 PSID <br />CHECK VALVE 02 CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />PASSED TEST ®YES ❑NO <br />PASSED TEST ❑YES ❑NO <br />CLEAN / REPAIR: ❑ see remarks <br />wx4Prs <br />vAIVE POSTIWLB AFTER nSnNG <br />SOV 11 []ON ®OFF SOV#2 ❑ON ®OFF <br />1E51FR ELLME <br />BATffxMGnON <br />TTST GAUR MAXE <br />GAUGE MODEL <br />TTST GUGESUU mHIRN <br />GNKEFHIBPAnmmn <br />Jason A. Moe <br />B4536 <br />Mid -West <br />845-5 <br />03051790 <br />01/08/2015 <br />W&IRLD BY <br />mfIPANV NAME <br />WME WHINER <br />N/A <br />- <br />FCULTESrBY <br />BOT mInnGnON <br />1[ST GAUGE MAXE <br />OAUGE MODEL <br />COMPANY NAME <br />MOVE NUMBER <br />N/A <br />BATman Testing <br />206 228-1618 <br />wTE DF vl K TEST <br />05113/2015 <br />sluanlXE <br />(I HEREBY CERTIFY THAT 1 USED WAC 246-290490 APPROVED, USC 10- EdWon TEST METHODS AND DIFFERENTIAL PRESSURE TEST EQUIPMENT FOR THE ABOVE TEST RESULTS <br />I' <br />