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BACKFLOW ASSEMBLY TEST REPORT <br />GATman Testinct,. <br />BACKFLOW ASSEMBLY TESTING AND REPAIR <br />OE RIFA[IUtt WUIE <br />m ,-r/OWTER,UIEE <br />WAMMR OR <br />The Reserve at Everett LIH <br />EVERETT PUBLIC WORKS <br />HFW @YBIRUCnON ASSFM&T/NSFOMEA IOR <br />MONF NUMBER FANWU m <br />WRMOROINFAC NAME <br />®Y ❑N Meter# 1852344675 <br />Tim Markham <br />SCRVI�AodIESS/METERNUMBER <br />pEiTOMERIOWNFA;WMACr MAIUNGAODRESS <br />N@V RFAT NUMBER <br />8920 Evergreen Way <br />425 257-8882 <br />QIY/STALE <br />.PWm <br />CET'ISTATE <br />RIP moE <br />WRVEYONFIURAOORESS <br />Everett WA <br />I 98208- <br />tmarkham@everettwa.gov <br />A4IMBLY MAXUFACRFEA <br />XooFt <br />SERIAL NUMBER <br />TYPE <br />SiTF <br />PTVMSIPfAM IR061S <br />MLKINS <br />950XLD <br />3984925 <br />DCVA <br />3/4" <br />FIRE SPRINKLER BYPASS <br />L AnONOFASYMBIY <br />Riser room at NE comer of building❑YES <br />Nfl love <br />ONO <br />omAUAnoNTYPE MIEVI MAKE IMODEL/Sa/SERULNUMBER <br />OEIERORRGO <br />® New ❑ Existing ❑ Replacement <br />N/A <br />OOXANTEOVEOABSENBEY(S IOIILLST) <br />® YES ❑ NO <br />I G WAnOY <br />VU <br />PROPER IxSFAl1AnON <br />® YES ❑ NO <br />WAIL IINE NVSSIIRE <br />80 PSIG <br />vAlVE P051110XS NUORTOIEBnN6 <br />SOW4l ®ON ❑OFF SOV#2 ®ON ❑OFF <br />INITIAL TEST RESULTS <br />TEST AFTER REPAIRS/CLEANING <br />CHECK VALVE kI CLOSED TIGHT ❑ <br />CHECK VALVE NI 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 42 CLOSED TIGHT ❑ <br />CHECK VALVE 42 CLOSED TIGHT ❑ <br />RPBA <br />LEAKED ❑ <br />LEAKED ❑ <br />ACTUAL PRESSURE DROP <br />PSID <br />ACTUAL PRESSURE DROP <br />PSID <br />ACROSS CHECK VALVE nl <br />ACROSS CHECK VALVEM <br />PASSED TEST OYESONO <br />PASSED TEST OYES ONO <br />CLEAN/REPAIR: ❑ see remarks <br />APPROVED AM GAP OYES ONO <br />APPROVED AIR GAP OYESONO <br />CHECK VALVE PI CLOSED TIGHT 2.4 PSID <br />CHECK VALVE NI CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />DCVA <br />CHECK VALVE k2 CLOSED TIGHT 1.7 PSID <br />CHECK VALVE 42 CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />PASSED TEST ®YES ❑NO <br />PASSED TEST ❑YES ONO <br />CLEAN I REPAIR: ❑ see remarks <br />PFMARI6 <br />VALVE PUSIIONS MTO, TESTING <br />SOV#1 ®ON ❑OFF SOV#2 ®ON ❑OFF <br />TTSNR NINE <br />BATWnnGMM <br />IESr GULE MIUT <br />GULENOOR <br />TEST GULF SDUAL NUMBER <br />G G mRAnm OATS <br />Jason A. Moe <br />B4536 <br />Mid -West <br />845-5 <br />03051790 <br />01/08/2015 <br />REPANW w <br />�FAW/ E <br />FMONE NUMBER <br />N/A <br />FLNA MvBY <br />BAT(ERnMGnON <br />TEST OAIIOE MAKE <br />GAUGE MOOFE <br />E PAMYAAME <br />PHONE NUMBER <br />N/A <br />BATmanTestin <br />206228-1618 <br />DACE W nNN TEBT <br />05/13/2015 <br />BILNA G•���iA✓- <br />I HEREBY [FATIFY THAT I USED WAC ]44]90490 AVPROVED, USE 10"EdMen TEST METHODS AND DIFFERENTIAL PRESSURE TEST EQUIPMENT FOR THE ABOVE TEST RESULTS), <br />