HomeMy WebLinkAbout2832 Outrigger Way - Special Inspections/Backflow - 04/19/200404/30/2004 14:15
Apr 25 04 02:36p
9706350426
RLAN FINBLEY
BELMIRE
PAGE 07
970-613-1309 P•3
LOVELAND PLU VIBING — 1022 West 33rd Street Loveland, CO 80538
BACK.FLO W INSPECTION SERVICE — 970-667-8971
BACKFLOW PREY ?NT?ON ASSEMBLY TEST AND MAINTENANCE REPORT
Customer mu: t retain a copy of this repo ] for a minimum of three years
Water DistricdAudux ity:. GW ' U �` d`)
Service Name I7 v—, t4PA A 1 0
Service Address: 2932 OUTR MER. WAY F ECOL.LINS, CO
Contact Person;_ Title: Phone;
Owner/Cmtractor/ly Wer SFV 41RE SPRINKLER/ 1 AMSCAPING, TNC,
Mailing Address: P.O. BOX 793 ! LOVELAND, CO $0537
Contact Person: IY Title Phone 970-667-7775 LA,
635-0426
New ■ Existiing❑ E eplacement For:
Use: Domestic ❑ Fire❑ Irrigation ■
Asaccably Irnw; Reduced Presm re U Doable (lock El Pressure Vacuum BreakerN Other
Mfg.: FEBCO Mom) io.: 765 Size: 3/4 Serial No.: H091075
Rate Tnstalied: Last Inspection: N/A Line Presence: 100 PSI
Location: N.W. CORMH DM
Check No 1 2.8
1tP DC t'1+8
check No 2 T-=k ❑❑
("IDC) Tilt ❑
Relief Valve
j'.TM
3.2
SbahofrvaiveNo. 1 Lank 0 Tiw
Sbut-o$valve No. 2 Leek ❑ Tight
ASSE TEST USED: 5010-1013-1 5010-1015-2 5010-1020-1_x� 5010-
RMWreComments: NO BACKPI; ESSURE
Assembly Mcchanieal Test: Passed ftiled 11
rMedaniwl tact 13dto, We wdw Huvey0d. udw *y nmec bo U0dW ifflwa dy said reW** made as won a possibtd
Technician ccrtiftcs thfq amembly h is bean tested in accordance with ASSL Proccdwes
Test Technician
: Alm Findley Certification No.: 2324 Pxl h=. 12/31/04
Sigrtiattae: l' Test Dwc: IWI Q/Aa Tlme: aw►,r
Phone: 970-667-8971 TcK Gauge Model; WATTS TK99E Gauge Re -Cent Date: 5/01 /04