HomeMy WebLinkAbout6020 HUNTINGTON HILLS DR - SPECIAL INSPECTIONS - 11/21/2000component Systems Q
Bsakibw Tes#ng Services L }l
(970) 472-9M
(970) 4824aS32
PRESSURE VACUUM BREAKER TEST &
MAINTENANCE REPORT
RETAIN A COPY OF THIS REPORT FOR A MINIMUM OF THREE YEARS
INSTALLAT-10t,
NEW:. DATE OF TEST l �/20
EXISTING: TIME OF TEST jj I
REPLACEMENT FOR : DATE OF LAST TEST -&A 4AZJ
PERMIT #:. 00 am,[,,
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SERVICE ADDRESs:(QQZ� Mf j Aq Od CONTACT l� �s�'� --PHONE -qC
BUSINESS NAME.A,�� CON'rCT: # oe. ► 4PsA_% PHONE q Z2
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MAILING ADDRESS: L5e70 QIA%,; 1 !!l�CITY: FT, 4 4 5_ STATE: -ZIP
DEVICE MAKE-_F MODEL: PM SERIAL NUMBER:���? � SIZE1�
USE: �, RESIDENTIAL IRRIGATION O COMMERCIAL IRRIGATION ❑ OTHER
LOCATION ON PROPERTY: S, �,c► P 04 h io a�,t —�
TEST RESULTS:
AIR INLET OPENED AT . -1�- Lam' , • -
ACROSSRETEST PSID
DROP
RETEST •
LINE PRESSURE AT TI ME OF TEST: _LW PSI
PASSED_
FAILED
TEST PR0CEDURM_K* Q-4 i0-f
TESTING COMPANY: Commoul 9v0rmN Tu I . --- ---
ADDRESS..2510 West WbKu_%[W —_—CITY: FV(LCo1 STATE:_QQ_ ZIP: 80521
GAUGE TYPERoMasler ASRP-4 `.... _ _ __— LAST CALIBRATION DATE: Ett �QOQ.__
CERTIFIED TESTER_QtWj"tCER71FIC/ATCN P 13" EXPIPA71ON DATE:M�r i5,>�001
SIGNATURE OF TESTER i,� _ �L — _� DATE /
—1 .
NAM OGNATURE OF PERSON NOTIFIED IF FAILED AND NDT REPAIRED:----� -- --DATE:---.-Y