HomeMy WebLinkAbout7200 Laramie River Dr - Special Inspections/Backflow - 06/22/200709/19/2007
11:45
9702046366
EVERITT COMPANIES
PAGE 03
Sep-19-2007
10:30am
From -MILL BROTHERS LANDSCAPE
.
970 483 4943
T-612 P.003/004 F-869
,onent Systems LLC BACKFLOW ASSEMBLLY TEST
rlow Testing Services & MAINTENANCE REPORT
,) 472-9773
CUSTOMER MUST RETAIN A COPY OF THIS REPORT FOR A MINIMUM OF THREE YEARS
,ater District _ L Meter/Acct. No: Test No,lDate: Z Z p
iervice Name: _ 5
Service Address:
Contact: Title:
Phone:
Owner/Mgmt Co/Contractor rG. L. o S'
Mailing Addnesss:
�.vnraoC TWO.,
p new u among
Replacement for Permit No.:
Use: ❑ Containment o Isolation
Domestic 0 Fire ❑ Commercial Irrigation y� Residential Irrigation ❑ Other.
Assembly Type: Reduced Pressure,< Double Check ❑ pressure Vacuum Breaker 0 Other._
manufacturer
—aLo Model: Size:
Date Installed- ,Serial No: D
q Last Inspection:_/V. o• N .� Ll a Pressure• LoCatlon: µ r ^CS r n'e.Li ..1' - _ - PSI
hhfen
Dmtetenial Comments
i
Check No 1 Leek
RP OC PVB Tight
T
,
Leek
Check No-2 Leak
r�AM
'
'Tight
C
Relief Valve
a
rLOW
Tr91N
Buffer
~1 or
' Zt� 0 �Ai2 t Y�
Air Inlet
r
R.
Sh" valva ft.1 Leak ❑
Tight ❑
Shut-off valve No. 2 Leak r i
mahr m I
Assembly Mechanical Teat Passed ,6 Failed 0 M mechanical sestfhite, the Water Purveyor/Authorffj, mumibe notified immediatsfy and repairs made Within 10 woridttg days,
Alarm Company/Fire Department notification:
Tum-off Date: Time:
Tum-on Daw- Time:
Technkian certifies this assembly has been tested In accordance with the following test procedure:
RP: USC 8,2,2 QJ ASSE• 013-6 D DC: US.C. 9.3.2 0 ASSE 101.5-5 D PVB: USC 9,4.2 p ASSE 1020-5 ❑
Tester Name: CC` otte Ha s Certification, No.: A A 06. VB:
Tester signature ,'',''; -� 1' Expires: Se t. 2009
-', Test Date:
Tester Phone:4Z2-s773 Time:
Test Gauge: M_ idwest W-5 01 Gauge Re-Cert Date: J nua 15 OOG
4dditlonal eartNimtions And gauges: ASSE e6d03, Exp, Aprrl 30, 2009; 11Aldweet e45 6 teZ ,fan. 19, 2007; C fl,F,S. ir076100]