HomeMy WebLinkAbout2821 Brush Creek Dr - Special Inspections/Backflow - 04/18/2002BACKFLOW PREVENTION DEVICETEST.'& MAINTENANCE REPORT
°PLUMBING &"HEATING'"
Service Address. 2S Z / 1�s ' `� City: St.
Contact:
l)Uu(_Phone: ZZ TZb Z.
�i t^- f'S Contact: ` f Phone:
Business Name: -�—
MailingAddress: Y� 3G� L-�,!� '�f/, % City;
/y N4 `5t: (16 Zip: 1YL..� 2b''
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Installation: New: V_ Existing: Replacement for #: Permit:
The Croon Connection Control Assembly detailed below has been tested and maintained as required by the regulations of the water
supplier, and is certified to comply with these regulations. �
Device Make: "45z cc Model: Serial#: ' �5ize:
Fill out next line only if device io a detector assembly.
Device Make: Model. Serial#: Size:
Name of Water Supplier: eN7� " d - �+ V Contact:
Location on property: o5�2& h,
Performing A55E Test Standard: ' G/
Use: Domestic ❑ Fire ❑ Irrigation [9" Other ❑
Device Type: Double Check ❑ Reduced Pressure ❑ Pressure Vacuum Breaker
Double Check Detector Assembly ❑ Reduced Pressure Detector Assembly ❑
'y
First Assembly Size:
Evaluation of: Isolation Valve #2
Air Inlet Valve 4`
Check Valve#1 Z
Check Valve #2
Relief Valve
Buffer Zone `3 '
Comments:
(Lompletc only ff Detector Assembly)
Second Assembly 5ize:
Evaluation of: Isolation Valve #2
Air Inlet Valve
Check Valve #1
Check Valve #2
Relief Valve
Buffer Zone