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� RedwoodBack{�ow BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br /> (445)495•1939 <br /> � �c�I-cv 5 <br /> WATER PURVEYOR Everett �1CCOU:�T p <br /> ASSEDtBI,Y ID/FILF,e;UTILITY�EVICC Dteter A <br /> NAD1E OF PRIs1111SF, HUghes Dental Commercial d Residential <br /> sEkvICE AuuRFss IOG25 19th Avenue SE �i7–/E 2��— Everett zip 98208 <br /> �ONTACT PERSON Head Mechanical PHONF. (425) 228-0071 <br /> LOCATIONOFASSF.l11BLY �Jac�� `�F Su1L41,,.L— �'^Cu{FwyrA < iLJO� Y'l�Zw�LL-� /�W�k/ <br /> D0IVNSTREAAf PROCESS Domestic Water DCVA RPBA � PVBA OTHER <br /> NE�V INS7'ALL d EXIS7'ING REPLACEDlEN7' REDIOVGD OLD SER.N <br /> APPROVED ASSED161.Y? YES � NO PROPF,R INSTALLATION? YES � NO <br /> AIAKF,OF ASSEMBLY Watts AIOUEL O� /M Z�Y SERIAL NO.���� SI'LE 1_� _ <br /> INITIAL nCVA / RPI3A DCVA / RPI3A RPI3A PVESA /SV13A <br /> CHECK VALVE NO.1 CHECK VAI,VP,' N0.2 AIR INLET <br /> TEST OPENED:�T�.� PSID <br /> CLOSED TIGHT � CLOSED TIGH'T ?C OPENED AT PSID <br /> PASSED x LEAKED I.GAKF,D p� �����ti�SiB <br /> FA[LED AIR GAP OK?� lliU NOT OPEN <br /> PSID PSIU <br /> QEAN REPLACE PART CIEAN REPIACE PART CLEAN REPIACE PART CHECK VALVF. <br /> NEW IIEI.D AT PSID <br /> PAR'PS ►.enKt u <br /> AND CLF.ANED <br /> RGPAIRS REP T.IRED <br /> TESTAFTF.R CLOSEUTIGfIT . CLOSF.D'PICHT {2V F.XF.RCISED <br /> AIR INI.E7' pSID <br /> RF.PAIRS <br /> LEAKED LEAKED o►�r:nen.�7' PSID <br /> PASSED <br /> FAILED <br /> PSID YSID �� cur:c�: PSID CIIK VALVE PSID <br /> AIR GAP 1NSPFCI'ION: Required minimum alrgap separation providedT 1'ES ti0 Detector Aleter Reading <br /> LEFI'S@RVICE AS FOUND�solution valcc: Open� Clused SOVNI OPen '� CloseJ SOV#2: Open Closed <br /> RF�tARKS: <br /> LINF. PRESSURE 1/l/ PSI CONFINED SPACF,? NO <br /> � `� ` oi-a6-zo�i <br /> TGSTLRS SIGNATURE: �-��L��`-�� CERT. NO. BSO`� DATF, <br /> TGS'I'ERS NA�II PRIN'i'lD 3ACK ALLENFOR'C 'CESTERS PiIONF,N (425)495-1939 <br /> RGPAIRIiD [3Y: CIiRT. NO. DATE <br /> FINAL 7'IiS'C IiY: CGR'1'. NCl llATE <br /> CALII3F2ATION DATE 11-12-2010 GAUGI N 10071SI7 1110UEL 111idH•est 835 SERVICE I�STORED YES� NO <br /> 1«tlify that Ihis repurt is accurate,and I have used WAC 24629U-0YO approved Ies�me�hods and test equipment. <br />