HomeMy WebLinkAbout1014 Burrowing Owl Dr - Special Inspections/Backflow - 01/31/2008Installation
Service Name:
Service Addres
Mill Brothers
Landscape & Nursery, Inc. 6121 East Harmony Rd. • Fort Collins, CO 80528 • (970) 493-3883
BACKFLOW PREVENTION ASSEMBLY
TEST & MAINTENANCE REPORT
New: _X_ Existing: Permit #: Phone: ,,W)- 7/0
Mailing Address: Uno0 Zon] S�
City: W'eS+ .'n5'6r State: 60 , / Zip:80,a3ti
Contact Person: Ak, �����yyP.7 Z Title: V; , pw li1
Assembly Make: I��JL o Model:
?65 'Pyb
/�
31LI ,I
Serial #: O7/� DLJ �O`i Size:
Location on Property: JillT�� W e5� CC*w C) 6 I`[)YYxQ
Water Supplier: C� -i
TESTS FOR DOUBLE CHECK AND REDUCED PRESSURE ASSEMBLIES
Direction of Flow: Check #1: psid Check #2: psid Relief Valve:
Leak Tightness: Check #1: Tight: Leak: Check #2: Tight: Leak:
Check Valve: 3-9 psid
TEST FOR PRESSURE VACUUM BREAKER
Leak Tightness: Tight: Leak:
Air Inlet: L�
Pass: _X_ Fail:
Repairs:
REPAIRS AND COMMENTS
Line Pressure: &LR />'C'
Comments:
THIS TESTER CERTIFIES THIS ASSEMBLY MEETS MINIMUM STATE AND LOCAL SPECIFICATIONS
.p "�
Tested By: a V � Uv- � Certification #: J C) _� ! L1f
5 Expires: 3.31 O
Gauge Type:
Pro Master
Last Gauge Calibration Date: L4 17 0
Date of Test: I 31 Time of Test: i r (.A) An Tester Phone Number: 493-3883
Tester Signature: Owner or Agent Signature:
WHITE COPY - OW ER YEI COPY - WATER UTILITY PINK COPY - TESTER ANNUAL RETEST REQUIRED