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\V � 1 I. BACKFLOW ASSEMBLY' TESTREPORT ® REMOVED;
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ASSEMBIY
LOCATION /I ( / ' 07'24 • (" 1If4 a--,.. //� _�
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REDUCED PRESSURE ASSEMBLY - - P V.BA / .V BA _; , INIT IAL TES
e w l cHE Cx DC3(IBIE CHECK Al R' S CHECKS : PASS,ED .
• PRESS DROP ° (A , CHECK # , INLET `, x ° • FAILED 3 ® , ` i
INITIAL RELIEF vqi vE `, �
..TEST R LICF A L (B)ITIGHT 2 7 OPEN AT PR DRO
MIN ]PSID - PS ID - - " DA . -
•RESULTS .BUFFR: (L
MIN EAKED ❑ �/ L / � i
A g' . CHECK #2 PSID' PsID
3 PSI
RELIEF 'VALVE ' T_IGIH 7. DID NOT - FAILED SYSTEM • :
. , - PSID OPEN ❑'
PASS " .FAIL ❑. LEAKED ❑ ❑ PSI r �� •
COMMENTS Fi . '4 .0 • V , .i' 'il4 '� L- / �/J 4 ,i'� ' / 9/ !`1", "/ /
1 REPAIRS . - .`•:,, ..
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REDUCED PRESSURE ASSEMBLY 1
41 CH _ P. V:B A - /S: V :B A' -;• AFTER`REPAIRS 1
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_ PRESSDROP - (A) ( �C'V A DATE: 1
TE , ,RELIEF - CHEC ......... I OPEN AT PRESS DRO
I AFTER OPENED . Ie) ' TIGHT. • P SID
1 REPAIRS �.:�ro ❑. �• / • .
BUFFTiR 1 CHECK 1 /2
B i I TIGHT PS ID PASSED I
P SID ' .. PStD _ ❑- - i
- IN COMPLETING AND:SUBMITIING THIS' TEST REPORT, . 'tHETESIER: CE R T IF . IES'•TIIATTHE f
ASSEM HAS BEEN TESTED. AND MAINTAINED - •IN ACCORDANCE WR ALL APPLICABLE _
_�R RULES ? AND REGULA� NS OF THE ATER- �SYSTEM, . , AND STATE' REGUI:ATIONSS`
`
I GAUGE CALIB TION DAT (GI /l / METER READING," += ` A _
-TESTER SIGN E / ����" . - 3758 . - . '
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'TESTERS NAM PO SO X181t BEAVERTON OR 57075 _ 7 � -. .
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TESrERsnooRess - ALL SEASONS BACKFLOW "
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COMP 'NA
i REPORT R. 1, EPS B SSE T7VE OF owNER) ❑ SERVICE RESTORED.
- ' WHITE \Vrta Systemic , - PINK . Customer COPY YELLOW Tester Copy -
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