Report /
60
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TI AUFENTHIE dba T &R Building Services
• 8660 Rogue Lane, Wilsonville, OR 97070 . 8 3 3 6
(503) 318-6313 FAX (503) 682 -4466 •
CCB# 116054 NEW
041% .
PNWS -AWWA BACKFLOW A.SSEIV(BLY TEST REPORT I REMOVED `
PROPERTY { CJ REPLACEMENT i
OWNER: 5' 0^ ?f2 0512 110imP
J PHONE:
MAILING
ADDRESS:
•
CITY _ „ STATE _ ZIP
DD M E B s j j 5 2 0 9 S G k/ ,S N 144 $1 eti 61/4_1 IF ?
AL)RESS: Q � � Cer
STREET
❑ R.P.B.A. dD.C.V ❑ R.P.D -A. ❑ D.C.D.A. El P,V.B.A. ❑ S,V.LA. ❑ A.V.B. Q AIR GAP
SIZE: 1 111410 MAKE: j4'M E$ MODEL: 2. C) 00
WATER - v 1 SERIAL ( )
PURVEYOR: 1 1 1 �j ll NUMBER: ' C 1 0 1
ASSEMBLY 1 LOCATION: T J l7- C) W LL
REDUCED PRESSURE ASSEMBLY P.V.B.A. i S.V.B.A. INITIAL TESL'
ill CHECK ..e�w;,, .. a�d,}�a.yw.•w
INITIA OPE DR°F m-----8')1 ( ` " C ' " "' AIR PASSED
CITE K # INLET � FAILED
RELIEY VgLVE (13): TIGHT , ( 7. OPENED AT'. PRESS DROP
M IN z PSID r MB? DATE:
TEST I LEAKED ❑
RESULTS BUFFER 1 CHE K PSIp PSID �/ # y f'
MIN 1 P51 • I
c *GHT A J DID NOT FAILED SYSTEM
RELIEF VALVE oLEAKED •5113 OPEN ❑ ❑ P51 ‘. , j
PASS
El ❑ ^^
CpMMBN -rs l - - -
REPAIRS lT
8 /
AND /OR I/
PART5
REDUCED PRESSUFB ASSeMeLY y AFTER REPAIRS
} C -HECK *''„ 1 'y,.u:a:;. t.Aita`a� P.V.)3.A. / 5 . V . B . A .
TEST PRESS DROP (AI DATE:
AFTER RELIEF CHECK #I U.ENF:D AT PRESS DROP
DPENF,D (PI. TIGHT ❑ PS(D / /
REPAIRS k /
BUFFER CHECK #z
A - B,- PS/13 PASSED ❑
M PSID ire > m , TIGHT 0 PSID
1N COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAI" nit
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WrTli ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIBRATION DATE 1 /Z. 3 R °. DETECTOR METER READING
3466 ,
TESTER SIGNATURE TIM A. AUFENTHIE 2p 0
1
TESTERS NAME. PRINTED 8660 Rogue Lane, Wilsonville, OR 97070 c � 318 a
9 (5p3)3186.313.':
TESTERS ADDRESS T & R Building Services PH()N .
COMPANY NAME
J. A Vr SERVICE RESTORED
REPORT RECEIVED 13 (REPR• 'NTATIVE
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