HomeMy WebLinkAbout455077 AMERICAN BACKFLOW & PLUMBING
SERVICES, INC
(877)-950-2468
Backflow Preventer Inspection & Field Test Report
PWS ID Water System Name Renton, City of File #
Facility Name Solera ☒Non-residential ☐
Residential
Service Address 2955 NE 11th St City Renton Zipcode 98056
Contact Person Angelino Phone 2532582781 Email robertm@trademarkplumbingllc.com
Hazard Type(if known) Trash Chute ☐DCVA ☐RPBA ☐PVBA ☐SVB ☐AG OTHER: RP
☒New ☐Existing ☐Replacement
☐Removed
Confined Space Yes No Location: Blgd. A South Tower L7 Trash
Room
Assembly Make Watts Model
LF009M3QT
Serial # 455077 Size 3/4 “
USC-Approved Yes☒ No☐Proper Install Yes☒ No☐ Proper Orientation Yes ☒No ☐
Initial Test
Passed ☒
Failed ☐
DCVA RPBA PVBA / SVBA
Check Valve 1 ☐Type II Relief Valve ☐Type II Air Inlet Valve
Opened at psid
Did Not Open ☐
Opened Fully Yes ☐ No ☐
Check Valve 0psid
Failed ☐
Leaked ☐ psid
Check Valve 2
Leaked ☐ psid
Opened at 2.2 psid / Not Open
☐
Check Valve 2
Closed Tight ☒ Leaked ☐
Check Valve 1 8.1 psid
Approved Air Gap Yes ☒ No ☐
Final Test
Passed ☐
Failed☐
Check Valve 1
Leaked☐ psid
Check Valve 2
Leaked ☐ psid
Relief Valve
Opened at psid
Check Valve 2 Closed Tight
Check Valve 1 psid
Air Inlet Valve
Opened at psid
Opened Fully Yes ☐No ☐
Check Valve psid
Air Gap Inspection Pass ☒ Fail ☐ Supply Pipe Meter “ Air Gap Separation “
Line Pressure 51 psi Detector Meter Gals CuFt Service Restored Yes ☒ No ☐
Remarks #1 Shut off found On ☒ Off ☐ #2 Shut off found On ☒ Off
☐
Upstream Shut off found On ☒ Off ☐
Test Kit Make & Model Mako MK5 Serial # 02AC21060168 Calibration Date 06/19/2024
By this
signature,
I certify:
1. I personally inspected and field-tested the backflow assembly using field test procedures meeting WAC 246-
290-490 and test equipment meeting WAC 246-292-034; or I personally inspected the airgap or AVB.
2. The information in this report is true, complete, and accurate.
BAT Signature(initial test) Cert# B6758 Date /Time 10/07/2024
BAT Name (print) Kao Saechao BAT Phone # 877-950-2468
Repaired By Date/Time
BAT Signature(after repair) Cert# B6758 Date/Time
BAT Name(print) BAT Phone# 877-950-2468
BAT Company Name American Backflow & Plumbing
Services, Inc.
Address 5623 SE Center St, Portland, OR 97206
Cleaning,
Repairs &
Parts
Cleaned ☐ Repaired ☐ Comment:
Disc O-Rings Diaphragm Check Spring
Spring Module Float Seat
Guide Rubber Kit Check Disc Air Inlet Spring Air Inlet Disc
*Note unapproved backflow preventer, missing/defective components, repairs made, or conditions that may adversely affect assembly.
**The date of the most recent field test kit verification of accuracy or calibration whichever is most recent.