Report WOMACK WATER WORKS, INC
CCB LICENSE #125943 14327
BACKFLOW ASSEMBLY TEST REPORT EXISTING
CARE OF: MAIN STREET APTS CIO REAMECH PLUMBING
crrY HILLSBORO STATE OR ZIP 97123
ASSEMBLY ADDRESS: 9356 SW MAPLEWOOD DR
DCVA .50 WATTS 007 60957 Li
WATER PURVEYOR: TIGARD i-1 �0��
ASSEMBLY LOCATION:SE CRNR OF BLDG J,BY LGHT
INITIAL TEST RESULTS
REDUCED PRESSURE ASSEMBLY PVBA/SVBA INITIAL TEST
#1 CHECK DOUBLE CHECK AIR CHECK PASSED_X_
PRESS DROP (A) CHECK#1 INLET FAILED
RELIEF VALVE TIGHT_X_ _2.2 OPENED AT: PRESS DROP
OPENED AT (B) LEAKED_ PSID DATE
MIN 2 PSID PSID PSID 012714
BUFFER CHECK#2
A-B= TIGHT_X_ _1.8 DID NOT FAILED SYSTEM
MIN 3 PSID LEAKED_ PSID OPEN PSID
RELIEF VALVE
PASS FAIL
COMMENTS
REPAIRS
AND/OR
PARTS
TEST AFTER REPAIRS
REDUCED PRESSURE ASSEMBLY PVBA/SVBA AFTER REPAIRS
#1 CHECK DOUBLE CHECK DATE:
PRESS DROP (A) CHECK#1 OPENED AT: PRESS DROP
RELIEF TIGHT_ PSID
OPENED (B) CHECK#2 PASSED_
BUFFER MIN 2 PSID TIGHT PSID PSID PSID
A-B=
MIN 3 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 CALABRATION DATE 02/23/2013 DETECTOR METER READING
TEST SIGNATURE CERT 5300
TESTERS NAME JOSEPH PRENTICE GAUGE 20863
TESTERS ADDRESS PO BOX 307,TROUTDALE,OR 97060 503 669-2722
COMPANY NAME WOMACK WATER WORKS,INC PHONE
REPORT RECEIVED BY: X SERVICE RESTORED
(REPRESENTATIVE OR OWNER)