HomeMy WebLinkAbout838 ROMA VALLEY DR - SPECIAL INSPECTIONS - 7/18/2000JUL-20-2000 THU 07:55 AN FORT COLLINS UTILITIES 9704162442 P. 01
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1235 Carlene Drive • -Loveland, CO 80537.667' -"74
BACKPLOW PREVENTION DEVICE � -lea. "
TEST AND MAINTENANCE REPORT
DATE OF TEST . " 1 8 - 0 C3 ES
FATE OF,l.A$T TEST.
OWNER'S NAME: TELEP D E M
SERVICE ADDRESS
MAILING ADDRESS:
The baakllow prevention device detailed below has been tested and maintalned as reaulrarl4Ythtawater>r�pliera11d1ef
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LOCATION DEVICE:"�f Off" INO1i34e coNTACTP.rmsoMAlP1TJ6(A AS
DEVICE tQ.� C-1*3 .," "*%�' /Q�i�T
LINE PRESSURE AT TIME OF TEST .0
/d U!P$1 PRESSURE DROP ACROSS FIRST CHECK VALVE PSI
INSTALLATION NEW )G_,. EXISTING REPLACEMENT FOR
Reduced Pressure Princtpsl Device
Double Check Vales Assembly Relief
lot Check 2nd Cheek %Ihm
Pressure Vacuum Breaker
Air Inlet
Cheek Valve
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COMMENTS: -AKlef &a 14XA
NAME OF PERSON NOTIFIED JF D IC FAILED A NOT REPAIRED:
WATER PURVEYOR:
TESTING COMPANY: .-Bokftw TwUng ServWba TE8TEIi:
ADDRESS: Carlene QftCITY STATEMP
GAUGE; TYPE: T CALIBRATION DATE: � f ON DATE: %
SIGNATURE: CERTIFICATION 11: DATE:..
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