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BACKFLOW ASSEMBLY TEST REPORT <br />BATman TestinaN <br />DACKFLOW ASSEMBLY TESTING AND R _PAIR <br />DSTONER/FAD NAME <br />WHIRR /ONNG NAME <br />WATER PURVEYOR <br />PUBLIC WORKS <br />The Reserve at Everett LIH <br />EVERETT <br />NEW CONSTRUCTION ASStTIBLYI CUSTOMER IDR <br />WMENUNBER FAYNUMBEA <br />tURVEYOR WIlTAR IINIE <br />®y ❑N <br />Tim Markham <br />SERVIQ ADORfis/NEIFA NUMBER <br />OISIOMER/OWTI�AIDdnAR MAIUNGA ccc <br />WRYRORFAK NUMBER <br />8920 Evergreen Way <br />425 257-8982 <br />MIRVEYDII EMAIL ADONISS <br />CRY/STATE <br />apW <br />QlY/SLATE <br />MPWDE <br />Everett WA <br />98208- <br />tmarkham@everettwa.gov <br />ASSDIBLY MAMIGACTWFA <br />MODEL <br />SERIAL NUMHA <br />IYPE <br />StiE <br />DO'MISIRFAN IRON <br />WILKINS <br />350A <br />U43060 <br />DCVA <br />6" <br />DOMESTIC SERVICE <br />IDCAnONOFASSENBLY <br />Riser room at NE corner of building❑YES <br />W111 .77E <br />ENO <br />IrarAwnan TTTF rnEVlous MNO:I Noon l s� / YRIAL nuMBDE <br />oETfcroR RfAo <br />N/A <br />E New ❑ Existing ❑ Replacement <br />OOII AR'ROVFD AS4NPIY (S♦yT 1013 LEST)I <br />E YES ❑ NO <br />ORIENTATION <br />H <br />OIIOPER IIRTNUnON <br />E YES ❑ NO <br />WATER IIHE PRESSURE <br />80 PSIG <br />vow Zmms NUOR TO TESTING <br />SOV#1 EON DOFF <br />SOV#2 EON DOFF <br />INITIAL TEST RESULTS <br />TEST AFTER REPAIRS/CLEANING <br />CHECK VALVE#1 CLOSED TIGHT ❑ <br />CHECK VALVE Ill 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 />VALVE#1 <br />ACROSS CHECK VALVE#1 <br />ACROSS Cl PECK <br />PASSED TEST DYES ONO <br />PASSED TEST DYES ONO <br />CLEAN I REPAIR: ❑ see remarks <br />APPROVED AIR GAP DYES ONO <br />APPROVED AIR GAP DYES ONO <br />CHI7CK VALVE 01 CLOSED TIGHT 3.5 PSID <br />CHECK VALVE#1 CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />DCVA <br />CHECK VALVE #2 CLOSED TIGHT 1.2 PSID <br />CHECK VALVE #2 CLOSED TIGHT PSID <br />LEAKED ❑ <br />LEAKED ❑ <br />PASSED TEST ®YES ONO <br />PASSED TEST DYES ONO <br />CLEAN I REPAIR: ❑ see remarks <br />RfMAAILt <br />vuvf PDmons AETEn TTsnnG <br />SOV#1 EON ❑OFF SOV#2 EON ❑OFF <br />TFSTIR NAMf <br />Jason A. Moe <br />BAT QAnnun011 <br />B4536 <br />11'ST GNIGE MARE <br />Mid -West <br />GAUGE MODEL <br />845-5 <br />TEST OREKi s' Num" <br />03051790 <br />GRIIGE ru1BRAnm DATE <br />01/08/2015 <br />RIl4RED BY <br />WfIPANY NAME <br />PHONE NUNRER <br />rl/A <br />FD'ALTESTBY <br />N/A <br />BAT CFATIDGTION <br />TEST GAUGE MAR <br />GNIGE MODEL <br />WIIPAM'MANE <br />BATman Testing <br />PHONE NUMBER <br />206 228-1618 <br />an v nxu TIsr <br />05/13/2015 <br />SIGNATURE <br />HEREBY CERTIFY THAT I USED WAC 246090i90 APPROVED, USC I Editlon TEST METHODS AND DIFFERENTIAL PRESSURE 7FSr EQUIPMENT FOR THE ABOVE TEST RESULTS) <br />