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ABC Water Specialty Inc. <br />Chnstfne Purdy <br />State Certified BAT <br />Specialty Plumbers License <br />Phone:425-355-9826 <br />si rvv SrW 0. North bnp. Skn o Canoes <br />DF PREMISE: �Z vy& 4r7 rzemil �JWATER _PUUR/VEYO�� <br />.E ADDRESS: Z�E� 6A.&) �Q /P �� � l�P�e(/ 9Y-?0V1 <br />ACT PERSON: PhOrte?f-„?S0-y0g7 Wrk Cell <br />R I PM. Contact Person <br />G ADDRESS: PHONE: FAX <br />TION OF ASSEMBLY: _� <br />OF ASSEMBLIES THIS LOCATION /_Col MAL RESIDENTIAL EXISTINGL_j NE� REPLACEMEENT <br />A13LY Man6facturer�� v _ Model ejv% QT Size 17 Serial <br />(STREAM USAGE! ( Q /ems LINE PRESSURE AT TIME OF TESTPOPSI <br />kTE: <br />INITIAL TEST RESULTS <br />No. 1 Check Valve <br />Differential <br />PSID Leaked <br />No.2 Check Valve: <br />Differential <br />PSID Leaked <br />Passed Test Yes <br />No <br />Apparent Pressure Across No. 1 Check Valve <br />Relief Valve Opened <br />3 PSID <br />No.2 Check Valve: <br />Closed Tight ® <br />Leaked a <br />No. 1 Check Valve: <br />Closed Tight ® <br />Leaked <br />Static Pressure Drop Across <br />Check Valve #1 <br />PSID <br />Minimum AIG present Yes No <br />Passed Test Yes Ri <br />No <br />Air Inlet: Failed to OpenLj <br />Opened PSID <br />Continued to Open Fully: <br />YesElNo ED <br />Check Valve: <br />Differential <br />PSID Leaked <br />Passed Test Yes <br />No <br />:OPERINSTALLATION <br />rks: <br />rs_ 00A-� <br />TEST AFTER REPAIR/CLEANING <br />No. 1 Check Valve <br />D.fferential <br />No.2 Check Valve: <br />Differential <br />Passed Test Yes <br />PSID Leaked <br />PSID Leaked E] <br />No <br />Apparent Pressure Across No. 1 Check Valve <br />Relief Valve Opened <br />PSID <br />No.2 Check Valve: <br />Closed Tight <br />Leaked EJ <br />No. 1 Check Valve: <br />Closed Tight 0 <br />Leaked <br />Static Pressure Drop Across <br />Check Valve 81 <br />PSID <br />Minimum AIG present Yes ONo <br />Passed Test Yes l ^ <br />I No I I <br />Air Inlet. Faked to Open LJ <br />Opened PSID <br />Continued to Open Fully: Yes oNo E] <br />Check Valve: <br />Differential PSID Leaked ED <br />Passed Test Yes No <br />YESLZNO 0 WASHINGTON STATE APPROVED ASSY: YESONO <br />Approved In DOH Pub # 331-137 (Rev. 11Aa) <br />IFY THE ABOVE REPORT TO BE TRUE: TEST EQUIPMENT: MID -WEST 845 SN# 09061797 <br />d Tester. Christine A. Purdue CALIBRATION DATE: Dec.9, 2008 CERT NO. B4187 <br />REPORT SENT TO i <br />i . , 7_ <br />11 <br />_Test Date: / ,?q' _6 <br />