HomeMy WebLinkAbout826 Benson Ln - Special Inspections/Backflow - 05/16/2003 (2)Lv4L i nI Ia- 1 I rrI Nita UULLINS UTILITIES 9704162442 P. 01
�Y�vwtce-�n
Water !
Service
ctor:
Metalkcc..ou
m�Vnt No.
Metal �
Title: Phone:
Contact Psrsonri_—Yi fi hAA is
Exlstingi 07 Novno Replacement Fori
USE1 Domestic: D Firei ❑ "--
Device type: Reduced pres•urs [I Double
Isolation.- L1 Containments Cl
Double Check O Prea TVacuum Breaker �'
Manufacture; e 1p Model. `�6�
9tzn _Serial No: _ 3
Date Installed) Last Insiaectlon/Testl
Location on Property- Malin Line Pressure: /�Slpgl
Reduc Pti��.,.�
--- - Double Check Type Fmssu
ffk* %Spring ---• ere
ss . Leak sluing
IMIn-is Tonal n If mahtneas
PSI L— light 0PGe __q. htT
Q Lakad Pal Li
i , sakasl �' �Psl
ao•�:t C Tight ; °Pei•► n Tight
..' ❑ Lsakad L.ekedPei
� Pal
b
g dual Check• Checks bested st min pf I.o psi C R�
o Device Mechanical Test: Pass KY Fail L�,s
e�Installation: Pxp1sU Meets State/locai Standards
Fails SUWLocal Standards:
Re -Test
Leak
Spring
Tightness
Tension
light
:7:_P31
-J Lsakad
PSI
1 Tlpht
Leaked
PSI
Pal
— PSI
Person nottfled of any failure:
----- ___ -- Title:
Alarm Company/Fire apartment Notified: _
TLrnsd off:_Rate) Tlme. TYfined on: Date:
' Tirnei
This isehnlclae Cartlllas this DrA" has bass lested! la accotdance with
the Most ascent Edition of the colorado Cross•Connaagon Control Manual.
Tested Byi
g ComPRIXY: cart. No. _Expires)�—
fe Street: City) Phone: 2�Z--
Test Equiptme ed cs AnState• Zip:
Technician:
Last Calibration Date:
1 ts:-� p Times 3 "'r.
~ Devi re Owner or Agerrt
� ure Date• Tlmei__