HomeMy WebLinkAboutDomestic Water Backflow TestWater Purveyor: DM Backflow Testing
P.O. Box 11082 • Tacoma, WA 98411 Backflow Prevention Assembly New
Existing
Replacement
Test Report 253-227-8858 ⼝
NAME: Fetala Tesla FILE NO:
SERVICE ADDRESS: 600 sw 10th st Renton Zip
LOCATION: _ inside south side vest to Drinking fruntin
CROSS CONNECTION CONTROL FOR: premisis Isolation TYPE ASSEMBLY: RIBA
MANUFACTURER ZUrN) WilKinODEL:
375 ASSIZE:
2.5 SERIAL NO: 5 8 8 5 8
INITIAL TEST RESULTS TEST AFTER REPAIR OR CLEANING
RPBA
Line Pressure
Pressure Drop Across
No. 1 Check Valve (A) 7,8 3 , 0 Relief Valve Opened (B) U. 8 Buffer (C) = (A-B) .
No. 1 Check: Closed tight
Leaked
No. 2 Check: Closed tight
Leaked
Minimum AG Separation:
Passed Test:
Yes
Yes
psid
_ psid
_ psid
ϩ X
ϩ
No
No
Pressure Drop Across
No. 1 Check Valve (A)
Relief Valve Opened (B)
Buffer C = (A-B)
No. 1 Check: Closed tight
Leaked
No. 2 Check: Closed tight
Leaked
Minimum AG Separation:
Passed Test:
psid
psid
psid
Yes
Yes
⼝
. ϩ
⼝
⼝
No
NOT—
Line Pressure
No. 1 Check:
DCVA No. 2 Check:
Closed tight
Leaked
Closed tight
Leaked
⼝ - psid
- psid
No. 1 Check:
No. 2 Check:
Closed tight
Leaked
Closed tight
Leaked
Passed Test: Yes _ No Passed Test: Yes
⼝
. ϩ ϩ
⼝
No —
_ psid
_ psid
Line Pressure
Air Inlet: Opened -
Failed to Open
_ psid Air Inlet:
PVB Check Valve
Leaked
Passed Test: Yes —
AG Minimum Separation: Y e s _
ϩ
ϩ N o ʔ
No
- psid Check Valve:
Passed Test:
Opened
Failed to Open. ⼝
Leaked . ϩ
Yes
No
PLEASE RECORD REPAIR OR CLEANING INFORMATION IN SECTION BELOW
_ psid
_ psid
IS THIS A PROPER INSTALLATION?
Water Service Found:
REMARKS:
Yes
On
No _
Off_ Water Service Left: On Off *
Test Equipment: Make
hid west Model
845-5 Serial# 03/205 97 Acuracy Verification Date
1/24/26
Assembly Tested: Satisfactorily Failed
I CERTIFY THE ABOVE REPORT TO BE TRUE
I certify this report is accurate, and that I have used WUC 246-290-490 approved Test Methods and Test Equipment
ertified Tester§' Typed or Printed Nam
Cert No. . Date Initial Test By 10 0 2/5/26
Signature Date Repaired By:
Cert No. Date Repair Test By: Signature