HomeMy WebLinkAbout6738 Autumn Ridge Dr - Special Inspections/Backflow - 05/16/2003ant 1c•11 rli VUKI UULLINS UTILITIES 9704162442
P, 01
�YDVw�C:��n
Water S
Meter/kccount No.
o w�only
Zip;
� Existlnpl D New:
.TelPhone:
USEI Domestic- ❑ 'rY)3323-ITL7
Replacement Pon
�
Device type Reduc pns Fiirslp Irrigation: � isdaAtian: Ci Containmeritl L�
Doubt Check D PLes ufe Vacuum Brea er
Manufacture: Modsi: j- �3 ,
Date Installedi �% 9iz°I- � _.Serial No: ZQ
Last I pectic stl AVA Main Line Pressure,
Location on Property: pr —'
Reduc Arm
Double Check Type
Pressunr Vacuum
Look —"
Inhtness spring Lank
aprinp
Brosker
Spring
Re Test
L"19gp�0
I
�htrMss i Tenslon
Tightrwss
Tension
^` _ nghtght
CJ Leaked
PSI
PSI
Leaked ' Pal
�--i Tight
Leaked
PSI
PSI
:•:;;: �i Tight °�+�'"'► : Tight
:._i
❑ Leslad Leakod
-Ill
�ht
Leeksd
-Psi
c____.Pal
_-
Psl
�
PSI
•0
" Qual Chack• Chocks tooted at min of 1.0 psi 1
m Device Mechanical Test: Pass Fail
Installation: Meets State/Locsi Standards
Falls
Explal
StatolLocal
Standards);
Person not:fled of any failure: ---
Alarm Company/Pirr Department Notified:
Turned off: Datst Tlsss
me: Tamed on: Date:
This TiMalclan Cert111es this Tlmsl
0 oevia has boss tested in Accordance with
the M091 meant Edition of e1e Colorado Cross-Connsegon Control Manual
�. Tested Byt00,
g Company: Cart. KIM _Ex9§9
E Street: Cityl 6 Ph7Z'•""'b Test Equiptme adl 3Technician: dart Calibration Datste:�Do
� Device owner or Agent
we
Date: