HomeMy WebLinkAbout1612 Streamside Dr - Special Inspections/Backflow - 07/06/2009Jul 06 09 03 04p Jennifer Brost
ABS SERVICES
IRRICA77ON SPECIALISTS
COMMERCIAL ' RtSIDEKl7AL
300 DUNNE DRIVE Backflow Prevention Assembly
rr COt.LINS, CO W525 -test and Maintenance Report
(970)225-0479
ERIK BROST
Assembly test results (I)Pass O Fail
970-225-0479 p 2
Assembly senal # Do 9 I A
TestdateAtme_ '7 Lys r2 jop
Gauge senal tt- O 508 zoj(.
> District neqtrred into
Tester certification # 15571
Date cerbfication expires S-3 12A I {
Water distraauthonty
Account Conlact person L.,�zey ,Qaciwc'72
FacFly [tame 1�6mES 402 out 7j&_aa0
5 Contact phone S- _470 SG` - 0 YrrS
Service address 14o / L STi2 cro in s /AE
b 0 i fnF h: r cc4.r u s. r n f:Q e. Oo 905 Z 5
Mailtngaddress /GiL S 'x7rrs.oE
t7RiyE F'futcrti+s Coc_oruo(t 21U52.5
O Owner (:)Manager ®Contractor
O Other Contact person i k= r317 oST
Comparry, nameJbtle A R5 SE2i✓ 1e ES
Contact phone # 4 70 i Z S- o `f 7 9
' Ma&Vaddress 300 QL)Nt.rdE"
M'r JE Fi [o,_c-i.-ts C0L0tL1.20 $OSZS
Malin Ccw/3z a Cd
Model qysO Y 0 2. Sae 3�v
Type ORPZ ODC ®PVB OSVB OAirgap
0AVI3 OOther
Date trislalled o Location on property t7fv7 sill r o r /-loin
(Only if applwable- include previous small[) Orientation Service
Protection
O Replacement assembly
1/71el Ou►reY O Domestic
O Containment
O New installation
r Vertical up T Q O Fire
(FF Isolation
O Stolen
r) 1 Vertical down 1 O ® Irrigation
O Containment
Previous assembly serial #-
(, -+ Horizontal — OOther
by isolation
tmt)W Test Results
Repaired— Cleaned
Re -Test
Results
Lane PSI /oo
Tightness
Ddlereriltal
C]Ck#1 ❑Ckd2 ❑RV 0Cks1 ❑Ck:r2 ❑RV
ckzi ❑Disc ❑Spring ❑Seat ❑Other
Tigfttrress
Differential
Check Valve 01
O Leah
f 3
O Leak
O Tght
jckrl RPZ oCPVa.SVBI
6 Tight
_ _ _
CR22- C Disc OSpnng ❑ Seat ❑ Other
Checlr Valve #2
O Leak
O Leak
O Tight
(Gk#r RPZ,DC)
0 Tight
Relief valve (RV RPZI
N/A
_
Rv C Dtaphram O seal 001her
Air inlet � Repaired ii Cleaned
NIA
Buffer (RPZ)
WA _
WA
O teak O Tight
N/A
Air inlet (rvs syB)
Air inlet Poppet Cl Bonnen O Oaten _
SOV N 1 r Open upon arrival O Open upon deparhrre
N/A
Shutoff Valve #1
Backpressure ensls9
-----
- — -
SOV ir2 Open upon arrival O Open upon departure
C)Yes ONO
Cause—
Shutoff Valve R2
C) tear BTighr
Assemby concems.
Test procedure
Comments
(ody d aPPTIMMe)
O ABPA OASSE
❑ Incorrect instaalton
❑ Incorrect use
ILm"Il dale
Tunron date
lur ll thne
Tier w wit
Alarm company/Fre department nOtlfled
Person notified
Contachad by
Turnoff dateA me
Turn -an datelbme
Test gauge make W I t.K ti l S Model T'G -,, Last calibration date 4 /
- Z W of
I hereby certify that the IsolabardShutoff valves (SON#1 and SOV#2) have been retumed to the position in which they were
bound and that the test was done accordingly to the procedure shown above required the by Water District Aulhonty, shown
above and the test readings are true and accurate to the best of my ability
-7 e,- v 7 N/tea
Tesler 9yiakne Date Customer 5grature Dare
SuOriul cqPY to Water Purvey"
WMU/G5