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HomeMy WebLinkAbout6120 Keswick Ct - Special Inspections/Backflow - 09/19/2000BackflowTesting Servicesflf'°°;1, 1235 Carlene Drive a Loveland, CO 80537.667-9874 BACKFLOW PREVENTION DEVICE ,r I� ~� TEST AND MAINTENANCE REPORT DATE OF TEST:` d © DATE OF LAST T OWNER'S NAME: M TELE E SERVICE ADDRESS: L I X0 Xcs (-j i C- C t° MAILING ADDRESS: The backflow prevention device detailed below has been tested and maintained as required by the water supplier and is certified to comply with these rules and_regulatiqns. LOCATION OF DEVICE: '� i be OF Adoslo DEVICE: eo ,r 13 �--7 6 c G LINE PRESSUF--EAT TIME -OF TEST PSI PRESSURE DROP ACROSS FIRST CHECK VALVE PSI INSTALLATION NEWS_ EXISTING REPLACEMENT FOR DATE Reduced Pressure Principal Device Pressure Vacuum Breaker Air Inlet Check Valve Double Check Valve Assembly Relief opened at 3, pal Closed fight . ° psi Leaked ❑ 1 at Check 2nd Check Valve Initial Test DC Closed Tight ❑ _ RP -paid Leaked ❑ Closed Tight ❑ Leaked ❑ Opened at paid Did Not Open ❑ Repairs and Materials Used After Repairs DC Closed Tight O RP-psid — Closed Tight ❑ Opened at paid Opened at psi Closed Tight O psi PASSED *-J^ FAILED ❑ COMMENTS: _ , -R f L, Lr�D NAME OF PERSON NOTII j D IF Dff CE FAILED AND NOT REPAIRED: WATER PURVEYOR: TESTING COMPANY: Backflow Testing Services TESTER: rAtJ ADDRESS: 1235 Carlene Drive CITY Loveland STATE/ZIP CO 80537 _ GAUGE TYPE: 5t-4.3 T CALIBRATION DATE: 7` 4 PIRgTION DATE: 7-01 — SIGNATURE: �, CERTIFICATION #: DATE. While Copy - Owner Yellow Copy - Water UnAlity Tag Copy • Tesler