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HomeMy WebLinkAbout2332 Chandler St - Special Inspections/Backflow - 05/28/2003Q 21 ALPS MECHANICAL ^' 970-5813AINTENANCE REPORT BACKFLOW PREVENTION ASSEMBLY�e TEST f ANDor a MAINTENANCE of three years Customer must retain a copy p Water District/Authority: _ Service Name: Name: Service Address: Contact Person: Phone:���' Owner/Mgmt Co/Contractor: Mailing Address: Phnne Contact Person: Title New 2 Existing❑ Replacement For: .__ Use: Domestic ❑ Fire❑ Irrigation ix Assembly Type: Reduced Pressure ❑ Double Check ❑ Pressure Vacuum Breaker Other Size: -3 Serial No.: 11764)3 8 25 Mfg.: Model No.: �_ PSI Line Pressure: --F Date Installed: Last Inspection: Location: oa_'rAct RPcrilts ASSE TEST USED: 5010-1013-1__ 5010-1015-2_ 5010-1020-1 PC 5010------ Repairs/Comments: Assembly Mechanical Test: Passed ® Failed ❑ it mechanical test tails. the Water NurveyorrAulhority must he nutiliwl imnudiately and repair made as stx0n as possible. ordance with ASSE Procedures Technician certifies this assembly has been tested in acc,11�0� Tester Name: Dennis 1 S Certification No.; Expires: 'rest Date: � ©'3 Time: � Tesler Signature: Tester Phone: 970-5814317 Test Gauge: WA'I-I'S TK99E Gauge Re-Cert Date: 5/1/04