Loading...
9430 SW CORAL STREET-5 0 i N n i 9430 CORAL, ST 04/21/2004 14:23 5036679891 WOLCOTT PLUMBING PAGE 02/03 I ;�•: ; ,WOMACK WATER WORKSr INC 395! CCB LICENSE #125943 BACKFLOW ASSEMBLY TLST REPORT E UOV EDM�� 11 OWNER 1 PROPERTY C� G',f1 i'�/l rHotaE: ,^ uAluNo � s! -- 's �v G �/I.�� Ste` 1 L\�► ` \ ADrxess: CITY STATE � ZIP ASSYMBLY - ADDRESS: STUE �R.P.B.A. ❑ D.C.V.A. []"D.A. 13 D.CA.A. OP.V.H.A. O S.V.B.A O A V.9. O AIR OAT, 617,E: I_U�L TZA MKE.WATER S AL PURVEYOR: /7���.� L�l1�lBER •�� ASSEMBLY LOCATION: �^ REDUCED PRESSURE ASSE&EL'V P.VJLA / LN.R.A DMIAL It CHEM � �,, Alit CHECK PAUSED I 0 PRISM DROP � A WBGC �3 liWLBT P n INITIAL alas AT (B TIGHT o/RNED Ar. M. DRDP DATE: Drn>sD wr LEAu RPSLILTS BUFFER iCHECK Irl MIN Em TIGHT DID NOT FAILED SYSTEM _ PASS P�FA1L ClILEAKEDn _POD OPEN ❑ ❑ PSI---_ .mtv>: 1 AND 1011 PAIn 1 xwXID►REiSuIR P.VJLAJR.V.RA AFTER RELR PAS n CNPCX s y:, • — DATE: Puss DROP_ t�1 CREEK M1 TFST �� I DPsI+ED At /Ritl DSA► AFTER OPENED (eZ TIO- IIT❑ vxD REPAIR$ eLWU rte. CHECK /2 — A' — T1011T ❑ PXJ6 IEm Pw PASSED [] I LN c�IrPLUING AND FAMM240 TKM IM APORT.THE ng=CgRTV=MLAT ASSENRLT MAS MUM TMW AND LMNTAWED QI A=RDAMM MRN ALL APPLJCAJU RULES AND RM"TIONS OF TNR MATU ST"%K AND STATE ROMMATMA OA.LIOE CAI.IHRATIONDATE V-EMSOMCTOR METER READING 2592 YES=sxn+eTURE �MAS�1L ri mm-—us Pu--4425 SW 109TH AVE, BEAVERTN 503 643 0466 rEirus Anc _K j j^ EZR. W 0$K S INC 8 97003 P►�DPrE r L UW^WY MAW .1 SER.VICP RESTrVED UPORT arcvvtrl T: aousswtATLvv OS OWNEN I EE:bG 999-EOG I 'SAMOM a31HM NOHWOM N3>1 Rr,ELOT 60 ET add 04/21/2004 14: " 5036679891 WOLCOTT PLUMBING PAGE 03/03 Y. ;..WOMACK WATER WORKS, INC 39353 !�v CCB LICENSE #125943 gw BACKFLOW ASSEMBLY TEST REPt7NT 0 PROPERT1 ❑REMOVED OWNER: L''�'L !r-l0 Tf` L l/ f�.G ,• a REPLACEMEW MAILING CITY STATX!f .e ztP P� I A98EMBI.Y t� ADDRESS: R.P.D.A. [1 D.C.V.A s ❑Rr.D.A ❑D.C.DA ❑P.V-B.A ❑s.V Ii A C1 A V.11 ❑Alit GAP WATER--1 idAK6: � MODEL:� A.,siM3Ly Numim- L(XATION:_.� REDUCED I'R1iSSURE ASSEJrMLY P.va / S.V.B.A. II pma" a AIR INITIAL TEST ►Rxr�pRw _q MU CHECK TASSEL) lNiTIAL KEMP VALVE c�-K / INLET FAILED" t] TEST OFEM AT_ 3• QtH)�TJOHT DP m Ar PSfOS oRor RESULTS LAKED Puu DATE: BUFFER (� y� A H I CHECK *2i8n -+- L� HwE� RELIEF V LYE I•I•IOHT DID NOT FAILED SYSTEM PAST FAIL ❑ L.E.AKSD❑ rsb OPEN❑ ❑ P8t a»o.rtrrta "PAW 1 AND lcut PAKM I CWCJ( ?FST ► DRrn P.V 9.AJE.V.a.A AFTER REPAW ASTFR "u" CHECJL MI — DATE: oPRHtI� I ,,, 0'"D AT REPAIRS ;� �.��rTI`OHT DIIOP eAFt� CHIICK MI -- TJOHT ❑ rwo -- -- PASSED ❑ >H CONPLEft?dD ANC SUWI q THIP 71SiT REFCW, MfEIDlLr WY SRQI TSSIED AND 6(AD7iIJNED q AC[a71tDA�1V1iSV ALD,��'g--w— SLLAif AM] RSgLRAr.DN$ Q no WASH! SYWMK AND STAT[ AL4 APP CA OAUOE CALIMIATJON DATE -+=�D C7Y1R INL >�A RMOLI T"m SI[A!A �— — 2592 _ N •W'�Mts�Jr 'rs`nI:"A.a'° 4925 SW 109TF AVE,"gEAV T 503643 ' r;r 0466 a�—y HA.CSA- --� - 0 5 ►►'�e�i �� Rsc n Ery ,wvgxrAmr cy �� - �ERw>L'k Rt�OR� z d EE L-999-F.CS ? `SX80M M31UM X3Uwf)n Nay 45E :0i 40 6i add