HomeMy WebLinkAbout6501 Brittany St - Disclosures/Final Energy - 11/11/1999FRONT RANGE TESTERS
1208 REDWOOD DR.
LOVELAND, CO. 80538
970-669-7036
BACKFLOW PREVENTION ASSEMBLY
TEST b MATNTF.NANCF RPPART
Installation: New:/Existing: Permit #:
Service Name:
Service Address: �_ S L1 1 M T "
Mailing Address:
Phone: S?,7-3 31d
City: r' State: zip: �G�Sr2Sr
Contact Person: Title:
Assembly Make: _ Model: Serial#: Size:
Location on Property:
Water Supplier: )5L L t V 0 Test Procedure #: / �',S' 2--
TESTS
FOR DOUBLE CHECK AND REDUCED PRESSURE ASSEMBLIES
/
Direction of Flow: Check #1: ! Y psid
Check #2:psid Relief Valve:
Leak Tightness: Check #1: Tight: Leak:_ Check #2: Tight: vLal�eak:_
TEST FOR PRESSURE
VACUUM BREAKER
Check Valve:
psid Leak Tightness:
Tight:_ Leak:_ Air Inlet:_
/
Pass: L Fail:
REPAIRS AND
COMMENTS
Line Pressure: c_I
Repairs:
Comments:
'Z_ G
THIS TESTER CERTIFIES THIS ASSEMBLY MEETS MINIMUM STATE AND LOCAL SPECIFICATIONS
Tested By: John Nelson Certification #: 318 Expires:c 2/o2
Gauge Type: Watts TK99E Last Gauge Calibration Date:
Date of Test: l Time ,of Test: `= G Tester Phone Number:
669-7036
Tester Signature: Owner or Agent Signature:
.i ANNUAL RETEST REQUIRED
WHITE COPY -OWNER YELLOW COPY -WATER UTILITY PINK COPY -TESTER
Installation: New:
Service Name:
Service Address:
FRONT RANGE TESTERS
1209 REDWOOD DR.
LOVELAND, CO. 80538
970-669-7036
BACKFLOW PREVENTION ASSEMBLY
TEST & MAINTENANCE REPORT
Existing:_ Permit #:
Phone:
Mailing Address: SU
lm e
City: �o ! i -�-7 S State: ��1 Zips-��rZ 5
Contact Person: �*- Title: p��
Assembly Make: �1'7ic S Model: 36L;C3) S Serial#: ��7t/ Size:
i
Location on Property: // � rd r -t't S; G , 40"
water supplier: z�C_ L �:_� n Test Procedure #: 16 !S " Z
TESTS FOR DOUBLE CHECK AND REDUCED PRESSURE ASSEMBLIES
Direction of Flow: Check #1: 3,6. psid Check #2: Z �psid Relief
Valve:
Leak Tightness:
Check #1: Tight: v/Leak:_ Check #2: Tight:-Z,,--%re-ak:_
TEST FOR PRESSURE VACUUM BREAKER
Check Valve:
psid Leak Tightness: Tight:_ Leak:_ Air
Inlet:_
Pass: Fail:
REPAIRS AND COMMENTS
Line Pressure:
Repairs:
Comments:
THIS TESTER CERTIFIES THIS ASSEMBLY MEETS MINIMUM STATE AND LOCAL SPECIFICATIONS
Tested By: John Nelson Certification #: 318 Expires: 2/02
Gauge Type: Watts TK999F Last Gauge Calibration Date:
Date of Test: IfIll y / Time of Test: _ ' -'��' Tester Phone Numberr:r '-669-7036
Tester Signature: Owner or Agent signature: Vt,t� �a
U ANNUAL RETEST REQUIRED
WHITE COPY -OWNER YELLOW COPY -WATER UTILITY PINK COPY -TESTER