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111. Existing
BACKFLOW ASSEMBLY TEST REPORT - Removed
Mil Replacement
Property Riverside Homes, LLC
Owner
Mailing 17933 NW Evergreen PI. Suite 370 Beaverton, OR 97006
Address Phone:503-645-0986
Assembly 7644 SW Hansen Ln. Tigard, OR 97224
Address
ED R.P.B_A. ® D.C.V.A.❑ R.P.D_A. 1=1 D.C.D.A. 1:3 P.V.B.A. ❑ S.V.B.A.ED A.V.B. ED AIR GAP
SIZE: in MAKE: Febco MODEL: 850
Water Purveyor Tigard Serial # 20613
Assembly Location: Next to water meter
REDUCED PRESSURE ASSEMBLY' DOUBLE CHECK P.V B A ; S V B A. INITIAL TEST
#1 CHECK INITIAL PRESS DROP (A CHECK #1 AIR INLET CHECK PASSED elTIGHT ��
TEST RELIEF VALVE 1 4 OPENED PRESS FAILED
RESULTS OPENED AT MIN 2 PSID (B) LEAKED El PSID AT DROP DATE(/�� (�
BAUF BER CHECK #2 PSDI PSDI 0122j20
MIN 3 PSI
RELIEF VALVE TIGHT ® 1 .6 DID NOT FAILED SYSTEM PSI
OPEN
PASS 0 FAIL 0 LEAKED ElPS!D ❑ 0 105
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D.0 v A P.V.B A SVBA.
TEST AFTER
#1 CHECK CHECK #1 REPAIRS
AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS
REPAIRS RELIEF 0 AT DROP DATE
OPENED' (B)
MIN 2 PSID CHECK #2 PSDI PSDI
BUFFER TIGHT PSID
A-B =
MIN 3 PSI PASSED 0
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
GAU TION DATE 12-19-19 DETECTOR METER READING
T TER SIGNATURE
TruScapes 503-707-0213 State Testers
Bonifacio Garcia Certification #6693
21600 NW Amberwood Drive Hillsboro, OR 97124 Gauge # 12171807
,I-PORT : C I`v'ED FY 0 SERVICE RESTORED
0 FOUND OFF, LEFT OFF