HomeMy WebLinkAbout424 Flagler Rd - Special Inspections/Backflow - 03/29/2001DATE OF TEST EXISTING KNEW PE
OWNER INFORMATION
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NAME M 4 P 4 arcs- 1� cf-,pllcr t.TELEPHONE # 37 7
SERVICE ADDRESS
BILLING ADDRESS CITY FI Go,//,.'.,,sSTATE/ZIP fj�eS�
WATER SUPPLIER f/�G _ �`� r1P ^ " ' CONTACT PERSON
DEVICE INFORMATION
Q IRRIGATION ❑ FIRE PROTECTION QSOILER_ El OTHER._
MANUFACTURER dC3,z,.4� a MODEL # ice' S SERIAL #-. A�5M ;7.2-p SIZE
LOCATION OF DEVICE JF S. ;pCg d 10 Z ..4
TEST INFORMATION
✓I -PRESSURE VACUUM BREAKER
SUPPLY PRESSURE _! P.S.I
AIR INLET OPENED AT _0-1. P.S.I. CHECK VALVE WITH FLOW Z1. 0 P.S.I.
CHECK VALVE TIGHT AGAINST FLOW? M YES ❑ NO
❑ REDUCED PRESSURE ASSEMBLY
1 ST CHECK WITH FLOW P.S.I.
RELIEF VALVE OPEN P.S.I.
2 ND CHECK TIGHT AGAINST FLOW? ❑ YES LINO
❑ DOUBLE CHECK ASSEMBLY
1 ST CHECK WITH FLOW I P.S.I
1 ST CHECK TIGHT AGAINST FLOW ❑YES LINO
2 ND CHECK WITH FLOW P.S.I.
2 ND CHECK WITH FLOW P.S.I.
2 ND CHECK TIGHT AGAINST FLOW ❑YES ONO
® PASS ❑ FAIL PERSON NOTIFIED O w �.---
COMPANY INFORMATION
TESTING COMPANY FORT COLLINS SPRINKLERS PHONE # 223-5625
ADDRESS P.O. BOX # 2202 CITY FORT COLLINS STATE / ZIP CO 80522
GUAGE TYPE ORANGE RESEARCH (5 VALVE) LAST CALIBRATION DATE (2710 1 o
TESTER ZCERT CATION # 2 ::�7 EXPIRATION 0 5 /v-F/O
SIGNATUR
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