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Report PLA1 -- l eO s = 0O;-9' 129500 / 10 NEW 0 EXISTING BACKFLOW ASSEMBLY TEST REPORT ❑ REMOVED PROPERTY' � _ ❑ REPLACEMENT OWNER: i y Pia, 1.---2 E «k� PHONE: erg s! -R 7 00 MAILING / J ADDRESS: K, o ' - , t S OY L r, �s CITY C i, ;, e Y > • �c+.i t" 1 '? STATE lif ZIP " � e.- ASSEMBLY = - , - y a -' 1 t4 k ! ° °� qq ADDRESS: '• •«.. - II._ • 's d 1 ,:4' d � i '-'" ..,. .' -. - `^? b ". G' - '1 1 (x-4 , �• c j STREET / `' ® R.P.B.A. ❑ D.C..V.A. ❑ R.P. A. ❑ D.C.D.A. ❑ P.V.B.A. ❑ S.V.B.A. ❑ A.V.B. ❑ AIR GAP SIZE: L1 ��i MAKE: •� A - ttS MODEL: 00 Q WATER ," SERIAL PURVEYOR: as V NUMBER: 3 7 2 0 7 ASSEMBLY .0 r LOCATION: ,-. 4j° C: r 7,,i) t..I-'� ,:r1 & r C)'�L. - 'e - /0 ©G' PAt_ m tot e;. - - - . - - - REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST N CHECK a L J':D.QUBLES §.CHECK:::; AIR CHECK PASSED,.L PRESS DROP i i ` (A)I CHECK #1 INLET FAILED Cr INITIAL RELI �°* > OPENED AT: PRESS DROP DATE: TEST O EF vALVE AT e B (TIGHT �� • . MIN2 PSID PSID ----,--. ----,--. BUFFER 'r ( PSID PSID LEAKED ❑ /0/241..C/ '� SD ` RESULTS A - B= - " '. ` a I CHECK #2 MIN 3 PSI RELIEF VALVE ITLGHT WI' DID NOT FAILED SYSTEM PASS 'a,. FAIL ❑ LEAKED r-, . OPEN ❑ ❑ PSI - 6 s 2 ego r 9 P °- c) -6., p ,fce Le�� COMMENTS REPAIRS AND /OR ' PARIS _ - • REDUCED PRESSURE ASSEMBLY P.V.B.A. /S.V.B.A. AFTER REPAIRS NI CHECK D.'CVA: : ' » :: :: TEST I PRESS DROP (A) CHECK #1 DATE: RELIEF OPENED AT PRESS DROP AFTER OPENED (8) TIGHT ❑ pSIU / / REPAIRS M 2Psm tUFFER CHECK #2 PASSED ❑ • ,.tW 9P9 I TIGHT ❑ PSID PSID PSID . IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS. GAUGE CAL1BRATIIO DATE �'- /- '' / //DETECTOR METER READING : �' / WAB2530/0R851 TESTER SIGNATURE 20682 CERT ARTHUR P. SELL 'E RS RI;O iIWTH ST. VANCOUVER WA 98663 360- 694 -0591 0 TESTERS ADDRESS PHONE N RFAC ON BACKFLOW LLC COMPANY NAME REPORT RECEIVED BY: ❑ SERVICE RESTORED (REPRESENTATIVE OF OWNER) WHITE - Water System Copy PI Customer Copy YELLOW - Tester Copy r' x;, `-1/0 /2010 09:46 :• °5033546391 GREEN THUMB PAGE 02 • ?1 • la `72c62— o 2_q f - si ;Y ir ; r , y , '4 s Ahl" , �( .1. N' ' '. , a �} A a i w h l ±l t f \ , �1 "n!1 � i 7M1 I +y �7 ; 5 -if... i , r t ' 9 t - -,' a ,,�r `1f a rl. cY"n�r •�i� s ' Ir75h1 v / "° 1 u i d 4 ,:4 " " r 1) l� T1� y ' � t X'.r F � 1 f . , <i 3 - r y t y F Z p A .A ! X11 h } i °�' II ',!Il: 1 ' '� i T f rYrr A. . , r l sl'b iy 11 i7S , 45,, I , t�Ai1,, It9' 1 C� �1 r , 4 1 �9 I,�1TE {,N3�, .. R , '' 1 i • 1 ','C +I t ° " `1 Y 'IA t' 14 A M t 1 r 5 'Vtig Ak 1 "Fn� 4�a� y ` {h �j S S wti;l ` r kii n ti�1 e eq u L u i n § I 1 3y C .' n, 4 1Z '] a'1 " R " . .50113sl ui � 1 ' . `t� _,..'".:k M (� I il liitEAfi V 6 v i i I Y4 1� 1. 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