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Correspondence Wt 4 3_1 — 20/0 C '/j n is Backflow American ! (503) 289.1745 1609050411 Assembly `_' 9osa.ixrens;rnrsa�E. NEW Test Report ��c�® -® y Pnrflaaael, p[¢ 97217 ❑ p TFST�a ©xEpAnts Services ' g EXISTING p INSTALLATION T �' ❑ REMOVED Property Ell REPLACEMENT Alpine pine View Lot# Phone: Mailing s 1 4248 SW Alpine pine Crest Way City: Tigard State: OR Zip: 97224 Assembly Address: 14248 SW Alpine Crest Way Tigard OR 97224 ❑R.P.B.A XD.C.V.A ❑R.P.D.A ❑D.C.D.A ❑ P.V.B.A El S.V.B.A ❑ A.V.B ❑ AIR GAP Size: J Make: p -2-({, LO Model: 0 Water Serial Purveyor: Tigard Number: / C— ( b7 a l 2 Assembly Location: k' V1Ati l---CA./ REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A INITIAL TEST #1 CH ECK • DOUBLE,C4IECK,t > > " AIR INLET CHECK PASSED PRESS DROP (A) I CHECK #1 INITIAL RELIEF VALVE TIGHT �i 2 4 OPENED AT: PRESS DROP FAILED ❑ TEST OPENED AT (B) I dJ RESULTS BUFFER A - MIN 2 PSID I LEAKED ❑ PSID DATE: B = - __ __. I___ CHECK - #2- PSID - PSID S /7 ( //o MIN 3 PSID I TIGHT K 2•C DID NOT . FAILED `� RELIEF VALVE OPEN ❑ ❑ ITEM �., PASS ❑ FAIL ❑ I LEAKED El PSID COMMENTS REPAIRS Q OUCD --7 t O0EDU AND / OR Uu / V ❑ �� D D PARTS V REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A AFTER REPAIRS #1 CHECK I.•,'DOUBLE :CMECK ` DATE AFTER PRESS DROP (A) ICHECK #1 REPAIRS RELIEF TIGHT ❑ PSID OPENED AT: PRESS D / / OPENED MI BUFFER M "2VSI 'CHECK #2 A - B = TIGHT E PSID PSID PASSED ❑ MIN 3PSID 1 PSID IN COMPLETING AND SUBMITII 1. I ST REPORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE r AL • PPLICABLE RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS. WATER METER # DETECTOR M R READING 4`` I' V L-"_ Washington CERT# 4660 TESTERS SIGNATURE Oregon CERT# Seth Weitzel 020372 TESTERS PRINTED NAME GAUGE # American Backflow Services (503) 289 -1745 07/25/09 COMPANY NAME PHONE # GAUGE CALIBRATION DATE 5905 N Interstate Ave, Portland, OR 97217 SERVICE RESTORED ADDRESS WATER FOUND DON '4,0 F 4/ y