HomeMy WebLinkAbout2101 S College Ave - Special Inspections/Backflow - 05/19/20101_
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ALL AMERICAN BACKFLOW
970-391-0006
215 East 2nd Street
Loveland CO 60537
Test DaWl'iime a/ er/ 14
Gauge Serial # �'--8
District Required Info Pry w a—. K
Tester Certrficabon #' ASSE 15220
Date Certification Expnes 3/18/2011
Assembly Test Results EjfitilSS [:]FAIL
Sackflow Prevention Device Test & Maintenance Report
(please print and submit completed copy within 10 days of the test)
Water District /Authority Account Contact Person
"
C Fatality Name Itl I A Contact Phone
0 Service Address )/ M) 5 ?05
v Mailing Address U
0 El owner ❑ manor pDontractior ❑ Der Contact Person
tCompany Name/Tifle no( S a „ Contact Phone a
Mailing Address / y 1 p S
Make 1 (� ti, S el r>Size
Type 4RPZ ❑ DC ❑ PVB ❑ sVB ❑ Air Gap ❑ AVB ❑ other Device
jalDate Installed JN ne Location on Property
EJ ❑ Revamnent Devoe Orientation , Service ro on
�prevrous device serial # Inlet Outlet P, r,,,,g,t
❑ Vertical up ❑ ❑ Fly Lsolabon
Isstallation ❑ vertical Down ❑
❑ Conlarnrtrent by Isolation
Stolen Honnontal}- Ottrer
Line PSI
Initial Test ResultsRepairedcan
❑ Ck#1 ❑ C k#2 ❑ Rv
❑ C k#1 ❑ Ok#z ❑ RV
Re -test Results
Tightness Differential
'Tightness Differential
Check Valve #1
Leak
Ck#1
❑ L�
RPZ DC PVB SVB
❑disc El spring ❑ seat ❑ other
❑ T
Check Valve #2
�VJ RPZ DC
L�
.3 ! l(/
Ck#2
❑ disc ❑ spring ❑ sit ❑ other
❑ L�
❑ Tot
e Relief Valve
RV
C RV RPZ
3
❑ Daphragm ❑ seat ❑ cow
Cr Buffer
'al
/ p
Repaired
Cleaned
RPZ
CD ! O
❑ Arr rrdet
❑ Air Inlet
�-, Air Inlet
Air Inlet
6 A let PVB SVB
❑poppet ❑bonnet ❑other-
«j Shutoff Valve #1
teak
SOV #1 Arrn� At Departure
Backpressure e)asts? YES
Cause
.� Shutoff Valve #2
Leak
SOV #2 upon Amval At
r Assembly Concerns
Test Procedure
Comments
only if apphcable)
❑ l ncorrect Installation
❑ ABPA
Incorrect use
Turn off date (� a
�❑
um on date a !
Turn off time �
Turn on time a ) 5
m arm Company Ire Department ob ed Ire suppression contractor ce0 82
tlr Person Notified Contacted by
°j Tum off date/time Turn on dabe/time
Y� Test Make Watts Model Last Calibration ate 6 0
! hereby oer* tlrat the andaBarVSM t l Vahes (SOV 3f and SOV 94 /aloe been relumed Ou Cie posibon m which fty ripe riwn0 anOCrat Cie cast test =done aawdmg to
Me proaedule drown above reWmW by the Water Dzbxt/Au#WW shorn above) and the lest readings are true and accurate to Cie best dmy abW
Jesting Company All American Baclkfiow (please print)
m Phone 970-391-0006 Customer Name Phone
�' (prease prnnt) l
Tester Name Lynnette Keim Tester Signature ustomer Signature