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After the Init(al TestlCerti!ication, all <br />Annual Test Results should be sent to: y I U U�1 -�a <br />BacMlow Prevention Assembly Test Report <br />Mailing Address Tester Information: <br />Coinpany �� �/�� Pl�iB!'�� �/krWl B.A.T.MASTER <br />Address <br />City <br />BackflowService.net <br />2918 Cavalero Road <br />Evereit, WA 98205 <br />Phone����/ Zl%�O 3� ��� � � (425) 210-9866 <br />%RR/ANi�I�,,l� t3�sH�r� p G <br />Servlce Address ���G �5 �- •"y- Serial N 32g �� <br />z.�.�;�,♦,,� <br />Company ---����//�I�/� Manufacturer W/LKIN.s <br />Address �� d S� �U�'�'��� �'`��`� Model 9�nI �XL <br />City �U��/ I Type /� r- u� 1 <br />�% <br />Phone Size � �5 <br />Permit Number <br />Reduced Pressure Princi <br />Double Check Valve Assembly <br />Check Valve #1 Check Valve #2 <br />Leaked Leaked ❑ <br />Initial Closed Tight ❑ Closed Tight ❑ <br />Test <br />Held at PSID <br />Repa:rs Cleaned � <br />Replaced ❑ <br />Detaiis <br />Held a� PSID <br />Cleaned <br />Replaced <br />Locafion ri.vdER �� t'Au'r �✓Ph=i 'rA�GE <br />le Assembly <br />Relief Valve <br />Did not Open ❑ <br />�pened at PSID <br />Cleaned ❑ <br />Replaced ❑ <br />Make <br />Model <br />SIN _ <br />Size _ <br />Line <br />Make <br />Model <br />S/N _ <br />Size _ <br />Irrigation Service <br />Make <br />Ffnal <br />Test Closed Tight � Closed Tight Model <br />Held at�-' / PSID Held aL�—PSID Opened a�� PSID S/PJ _ <br />Size _ <br />Comments:��� �� p5i <br />l�� " i�tl�N6 5 "�ia <br />hu�1 d� Lh%% u/'/� <br />The above report is certified to be true. <br />Date/Time Tester (Prinl <br />INtial �, ,, . / ./------ <br />RepaUs rry �� <br />Final �1 �I <br />PqIME01NT1EU.5A <br />Meter Reading <br />Meter Number <br />Test Kit Model � ' " <br />Kit S/N �d5 � 7 � <br />Calibrated Date Z � �� <br />State License <br />Vehicle # <br />Tesier # <br />Passed Failed <br />❑� <br />� ❑ ❑ <br />.� � � <br />p.nvqponi e ump.mr n.cam <br />