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Home My WebLink About2023.06.14.TRI.S.Backflow Test Report6Hl't{i$l( h7T=$E-IANICAE- Itrl{itl I - AT[(]N,,-, u, BAGKFLOW PREVENTION ASSEMBI-Y TEST REPORT AUTI{ORIZED TESTER ..; FILE#_ SCHEDULECODE FACILITY NAME CommercialA Residential I CONTACT NAME H.A.ZARD rvpl?4)lt0ti',y2 6upp4 - BVPAss DCvA f nneaft pvBA E AG E orHER- NEw INsrA", I u*r.rrNc I RErLACEMrNT I olo sER. # -- pRopER rNsrALLArro*, ur, ffiNo I MAKE o,,AssEMBr,vtr)Arr-na oou, lswl nzff 'ERTAL No.lb9a53 STZE 2" sERVrcE ADDREss ^ Y / 5 SIJN DEr la r.r r crr, fkNroi o, l Bo€L TQt.sTFr P ^iB,Nq pHoNE({zs) 642.3?r3O rmr ASSEMBLY LOCATION INITIAL TEST rassnoffi FAILED E DCVA/R}BA CHECKVALVE NO,1 learco I q,4 PSrD DCVA/RPBA CHECKVALVENO.z leeruo flt/r PSrD RPBA oPENED et 3,?, psto +r cHBcr 9,t/ psin ./ AIR GAP OK? V PVBA/SVBA AIR TNLET OPENED AT-PSID DID NoT OPEN tr NEW PARTS AND REPAIRS CLEAN REPLACE PARTftrurlrtrtrtl PARTTTrtrTT['r PART ITtrtrlnun CHECKVALVE HELD AT LEAKBD CLEANED REPAIRED TEST AFTER REPAIRS PASSED n FAILED N lre,rct f PSID LEAKED I PS]D OPENED AT PSID #1 CHECK_PSID AiR INLET -PSID CHKVALVE PSID AIR GAP INSPECTIONI REMARKS: Supply Pipe Diameter Separation Passfl Failf] TESTER SIGNATURE: TESTERNAME PRINTED: REPAIRED BYI ObLt\ rEsrER PHoNE * 125 31 43 | ' b'1 DATE FINAL TEST BYI CERT. NO. -DATE cALIBRATT9NDATE -1,-h r1-3 yloot*oD*L ['nid-Wett W .AUGE # Lbzlo'TlL I ceftirt' thTt tltis rep1|t is accut'ste, cud I hsve tsed WAC246-290-490 upprotel test rrelltods and test o.luiptilettt, LrNEPREssoup ?a ,., coNFTNED spacsz NO l:.. ffiltE "I{,t{/ffi=$E-lANl$ t( A$*BACKFLOW PREVENTION ASSEMBI-Y TEST REPORT AUTHORIZED TESTER CornmereiatA Residential IFACILITY NAME \ sERVrcE ADDREss ^ Y I s Our.r aer la nr g "rry PENTIA o, I 06L' HAZARD rvw 7FiP'45iH CUW? aons$ manl ocva fl onroft nvra fl AG E orHER LrNEw INsrAr,r, f,nxmrnrc[ REpLACEMTuT[olo sER. # pRopER TNSTALLATTo*, u"rfiNo[ MAKEoF,ASsEMBn-NArrs-*oow@trt?eT_sERrALruo. 36'l tAl rrru tilr{$Bt J I-AT[(]td,,-, ., F'ILE #SCHEDULE CODB coNrACr NAME TA.ATXFc PLn riFr Nq pHoNE (r{zsl 642 . 3?rSO r;-lx t ASSEMBLY LOCATION AIR GAP INSPECTION: REMARKS: Supply Pipe Diameter.Separation Passfl Failfl LrNE PRgssuns 39 psr TESTER SIGNATURE; TESTERNAME PRINTED: REPAIRED BY: coNFTNED spacpr NO cERr. No. @62J\ oll;n L,14,1D?3 rEsrER PHoNE * 1 25 31 4" I' 3'12 I TE FINAL TEST BYI CERT. NO,DATE cALTBRATToNDATE -1,-h r23 yrlrro,twoDuL fnld'West W GAUGE # ovzloTl2^ INITIAL TEST PASSEDEI FAILED E DCVA / RPBA CHECKVALVE NO,l lenren fl PSID DCVA/RPBA CHECKVALYE NO,z lneren I PSID RPBA OPENBD AT- PSID #1 CHECK PSID AIR GAP OK? - PVBAiSVBA AIR ]NLET OPENED AT-PSID DID NOT OPEN tr NEW PARTS AND REPAIRS IfIuutrTtr PART trtruniItrr'tr CLEAN REPLACI,f,ntrxtrtrTN PART CHECKVALVE HELD AT PSTDLEAKED T CLEANED REPA]RED Ttr TEST AFTER REPAIRS PASSED I FAILED [I rumeo fl PSID LEAKED T PSiD OPENED AT PSID #1 CHBCK_PSID AIR INLET-PSID CHKVALVE PSID I cefiifi] thilt tltis report is flccut'ste, antl I have userl WAC' 246-290-490 uppt oyei test tttetltods aild test aquipnent, BACKFLOW PREVENTION ASSEMBI-Y TEST REPORT FILE #- FACILITY NAME SCHEDULE CODE_AUTHORIZED TESTER sERvrcE ADDRESS 21 t s SrJNDrr 2a nr g CONTACTNAME PH0NE (tz.Sl b4s.b$so FAX ( ASSEMBLY LOCATION AIR GAP INSPECTION: REMARKS: $FHTiUK N/ffi=CE-lAtdt$AE- IttHiUl-ATl()N,,-,u, -il6flfs CommerciatA Restdentialf "rrt {?ENro,J ,ry l oNL HAzARDrrn, ?u,rO,r*rr, FrpprJ DCVA f nnraft rvna f] AG E o.rHER- NEw INsrAr" [ *rr.rmc I RErLACEMrnT f om sER. # - pRopER rNsrALLATror, "r, fiNo I MAKE otr'AssnMBr,v-Lhzis--naoonl 616' sERTAL No, VE - l'.l 2-t s,r, 6 " INITIAL TEST rassroffi FAILEDtf leereo fl g,{ DCVA/RPBA CHECKVALVE NO.1 PSID DCVA/RPBA CHECKVALVENO.z lrarco fcl*I I PSID RPBA oPENED ar 2.6 psrn #1 cHECK 8.4 psm ./AiR GAP OK? V PVBA/SVBA AIR INLET OPENED AT-PSID DID NoT oPEN tr NEW PARTS AND REPAIRS CLEAN REPLACBuIINuxItl PARTCLEAN REPLACETtrIIIfI'n PARTIuInrtrItr CHECKVALVE HELD AT PS]DLEAKED tr CLEANED l_lREPAIRED N TEST AFTER REPAIRS PASSED f FAILED E learen f PSID LEAKBD T PSID OPENED AT PSID #1 CHECK_PSID A]R INLET -PSID CHKVALVE PSiD Supply Pipe Diameter Separation Pass[ Failf] LrNtr PRtrssr*n 10 na, coNFTNED spacez NO TESTER SIGNATURE: TESTER NAME PRINTED: REPAIRED BY: cERr. No. fi62.14 DArE L, t4,1fr?3 4,81.?.'1 5 |rEsrER PHoNE * 12531 DATE FINAL TEST BYI CERT. NO. -DATE cALIBRATToNDATE I,-h r23 mxg3nronIq- fTlic)-t{esf W cAUcE # 07Zlo'7lL I certirt' thilt tltis ropot'l is tccurttte, aud I have usert WAC246-290-490 upproted test ktethods aild test 7quipneilt, YAKI 6Hlt{iul( N/rHCl"tAtdl$At_ lNsiul-ATl()N\,.,u, FILE #AUTHORIZED TESTER CONTACTNAME CommerctatA Residential fFACILITY NAME \ sERvrcE ADDREss ^ Y / s tur.r aer la nr g "rr, [kNroA ,t, 1 ho€L. TQl.sTAr PL MB, Nq pHoNE (rtzsl 642. 3?r3o etxr AssEMBLyLocArroN frrzE lggnptta Rrcee- RooM HAzARD"rn, GrA,L ABal DCvA I nenaft nvna f] Ac I orHER NEw rNsrAr" ffirrrrrruc f RErLACEMTnT[om sER. #PROPER INSTALLATIO*"" ff NO T MAKE o,'AssEMB"rlilXEs-*oorr, LF8cl,MzcrT 'ERTAL *o. -t g "" Lt Ll srz*7.o" BACKFLOW PREVENTION ASSEMBI-Y SCHEDULE CODE INITIAL TEST passnok pau,pn fl DCVA / RPBA CHECKVALVE NO,1 r-rarcn I q. U, PSrD DCVA/RPBA CHECKVALVENO.z lre.rcu flc/a ,rro RPBA oPENED ar 3,6 psrp #r cHBCK I ..b psm ,/ AIR GAP OK? \/ PVBA/SVBA AIR INLET OPENED AT_PSiD DID NOT OPEN tr NEW PARTS AND REPAIRS trtrfuunutr REPLACE PART utrnlun['tr CLEAN REPLACE PARTTtrtrtrTtrutr CHECKVALVE HELD AT-PSTDLEAKED I CLEANED REPAIRED trT TEST AFTER REPAIRS rassnn I FAILED E maren f] PSID LEAKED I PSID OPENED AT PSID #1 CHECK_PSID AIR INLET -PSID CHKVALVE PSID AIR GAP INSPECTION: REMARKS: Supply Pipe Diameter.Separation Passfl FaiI[ TESTER SIGNATURE: TESTER NAME PRINTED: REPAIRED BY: LrNE pRnssups 9o psr coNFTNED specpr NO cERr. No. B62l\ DArE L. 14,1D2S 4?t.?.'1 5 |TESTER PHoNE * 12531 DATE F.INAL TEST BYI CERT. NO.-DATE cALIBRATToNDATE -4,-b r23 *oror*oDuL fnid-Wasf W cAUGE # \bLloTiZ f cefiirtl thilt tltis rcpor! is accut'(tte, aud I have userl WAC'246-290-490 upproted test hlatlrods and test aquipnent, ::'' @rr{iur( h"fil=$E-lANl()At* lilrl$iU I - AT I ()td,,-, u, FILE # FACILITY NAME sERvTcEADDRESs -Yr5 Sr.NDEz larug CONTACTNAME SCHEDULE CODE- AUTHORIZED TESTER -MEITITS CommerciatA Residentialf "rr" [kNroA ,r, 1greL T4I TA'I pLn ib, Nq pHoNE (rtzsl 649 - 3?r3o rdxr EVENTI ASSEMBLY LOCATiON HAZARD TYPE NEw rNsrA", f, u*rr"rruc I RErLACEMrNT f olr sER. #PRoPER TNSTALLATTo*, "r. fi No E M^4,K8 or AssEMBLyldltrS-Moonrl=E@nazGc-sERrAL No.bgbL\q,SIzp 1.5 * ucvn f] onnofi rvea fl AG I orHER Separation Passfl FailflAIR GAP INSPECTIONI REMARKSI Supply Pipe Diameter LrNEPREssunp to ,s, .coNFrNED specsz NO TESTER SIGNATURE: TESTERNAME PRINTED: cERr. xo. fib?.14 DArE L. t4,Lfr% rEsrER PHoNE * t2531 431 '3''l 5 | REPAIRED gY, DATE FINAL TEST BYI CERT. NO. -DATE cALIBRATT9N DArE -4,-b r23 yoo1*oow. fYl td-WeSf W *AUGE # 'TLloTlL INITIAL TEST PASSEDX FAILED'E DCVA/RPBA CHECKVALVE NO.1 lrarcnn I 8,L PSID DCYA/RPBA CHECK VALYE NO.z PSID RPBA oPENEDa.r 4,o pstn #1 cHECK B,t psrn ,/ AIR GAP OK? V PVBA/SVBA AIR TNLET OPENED AT-PSID DID NOT OPEN tr NEW PARTS AND REPAIRS ruIuufIrl PARTTtrTtrtrrlT'T PARTCLEAN REPLACEuf,trnItrutr CHECKVALVE HELD AT LEAKED PSID CLEANED XREPAIRED f TEST AFTER REPAIRS PASSED N FA.ILED [I rneren I PSID LEAKED I PSID OPENED AT PSID #1 CHECK_PSID AIRINLET-PSID CHKVALVE PSID I certifi' thilt tltis replt't is occut'ste, aud I have used WAC 246-290-490 upprot,ed test hrcthods atrd test e(luiptileftt,