Report i1.: ; l i - ° x (503) 289.1745
p -act.
Assertil}%` ;.0 ®�1 NEW
y
Test e rt s G o moo av ams • a`. E EXISTING
u. r yJVSraa s ATION r _ ° Vie `= ,
ir ❑ REMOVED
❑ REPLACEMENT
Property
Owner: Barry Garriety Phone: (503) 803 -8729
Mailing
Addres 13881 SW Fanno Creek Drive
city: Tigard State: OR zip: 9722
Assembly
Address: 13881 SW Fanno Greek Drive Tigard • OR - 97223
dr IELD.C.V.A 0R.P.D.A. 0 D.C.D.A 0 P.V.B.A 0 S.V.B.A II]A,V.B ❑ AIR GAP
Size: ... . _... _. _ Make: 1 I f C i L � Model: q s- 7
Water Serial
._
!Nate
TIGARD �J
e y o r : Numbe 2 4( Sb
i
Assembly —71, ' �^
n ., O
R PRESSURE ASSEMBLY. F , / S.V INITIAL TEST
., ! I `6
• '�.��r1 -cHECk - IF' - DOUBLE CHECK AIR INLET .. ' CHECK PASSED
'`;''= r - (A) #1 .
I . : ' CHECK
"` '= CHECK Z •L OPENED AT PRESS DROP FAILED 0
HT Jo
LEAD ❑ ID DATE:
PSID PSID
-�
TIGHT 17_, _ '
r r f;.
Z• �' DID NOT - FAILED
„:„.5„4,,- ' ! E� PSID PS OPEN Et SYSTEM
� PSI ❑ ❑ C
rt 7
\t A , *L Y RR.�"" 111 ' ' -9 ,''
° _ " " REDUCED PRESSURE ASSEMBLY
PRESS CK AFTER REPAIRS
TEST PRESS DOUBLE CHECK :.''
AFTER � #1 DATE:
REPAIRS RELIEF _,
OPENED �B ❑ PSID OPENED AT PRESS DROP
• BUFFER MIN _PSI
A - B _ 'CHECK #2
MMJP$yp TIGi— ❑ PSID :' PSID HAT THE ASSEMBLY HAS BEEN TESTED AND
PSID . PASSED ❑
IN COMPLETING AND SUBMITTING THIS TESTREPORT, THE TESTER CERTIFIES T
MAINTAINED IN ACCORDANCE WI . ALL FE , ,,YABLE ES R ANO REGUTArx OF THE WATER SYSTEM, AND STATE
WATER METER # - DE TE CrOR :M .
� Washingt I CER T#
TESTERS SIGNATURE i
R •
4610'
;;,TESTERS PRINTED NAM OtCfIICISS Oregon CERT #i
} , Auttlelrecgala Eaackfl®w Ave P Services 020372
tlM�ANYdN 9 03 2 89 -9 745 GAUGE #
- n7 IY' Int�'fS aq — PHONE # .___ 3129/08 __ 1ON __
[� Portland OR 97217 GAUGE CALIBRATION "D TE .
— SERVICE RESTORED �
WATER FOUNp; lON DOFF