HomeMy WebLinkAbout2208 Chandler St - Special Inspections/Backflow - 05/14/20046 ((:)(-AM � 6'�
ALPS MECHANICAL N 970-5814317
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Customer must retain a copy of this report for a minimum of three years
Water District/Authority: i�
Service Name:
Service Address: 2421 �+At,-, -t.[ f t ja
Contact Person: f t<, sA- Title: (1,0 _Phone: n,
Owner/Mgmt Co/Contractor:
Mailing Address:
Contact Person: Title
New ® Existing❑
Use: Domestic ❑
Replacement For:
Fire ❑ Irrigation Iff
Phone
Assembly Type: Reduced Pressure ❑ Double Check ❑ Pressure Vacuum Breaker Other
Mfg.: ae.Ac , Model No.: �46S Size: `f Serial No.: /y -V
J9'
Date Installed: Last Inspection: Line Pressure: .el PSI
Location: J4,z i s� - =pe/ f �bLLr P
Initial Test Result
Comments
Re -Test Results
Tightness Differential
Tightness Differential
Check No 1
Leak
®
Leak
RP, DC, PVB
Tight
Tight
Check No 2
Leak
Leak
(RP, DC)
Tight
Tight
Relief Valve
RP
Buffer
RP
'e-=x
Air Inlet
PVB.
Shut-off valve No.
1 Leak ❑ Tight
Shut-off valve No. 2 Leak ❑ Tight
ASSE TEST USED: 5010-1013-1 5010-1015-2 5010-1020-1_X_ 5010-
Repairs/Comments:
Assembly Mechanical Test: Passed C ] Failed ❑
If mechanical test fails, the Water Purveyor/Authority must be notified immediately and repairs made as soon as possible.
Technician certifies this assembly has been tested in accordance with ASSE Procedures
Tester Name: Dennis Alps Certification No.: 1811 Expires: 71124
Tester Signature: Test Date: -5 _)u - 425f Time:
Tester Phone: 970-5814317 Test Gauge: WATTS TK99E Gauge Re-Cert Date: 5/1/04