HomeMy WebLinkAbout6308 CLYMER CIR - SPECIAL INSPECTIONS - 9/2/200511 06P
8 b �60( F XK1
Awesome Sprinkler Guy LLC 2432 Ridgeerest Rd. Ft. Collins, CO 80524-1593
INS LIACKFLOW PREVENTIAGN ASSEMBLY TEST AND MAINTENANCE REPORT
Customer must retail a copy of this report for a minimum of three years
Water District/Authority: 1/? Meter/Account No.: Test No.: �/- (kilt "� ' `
Service Name: f9jr / i �/` dew � � `Z JG .�
Service Address: 4,08l �� �l/,NS �0
Contact Person: Title: Phone: fie/ - t 77
Owner/Mgmt Co/Contractor:
Mailing Address:
Contact Person: Title: Phone:
Newer ExisAg ❑
Repladsmetft For.
Use: Containment ❑ Isolation ❑ Domestic ❑ Fire ❑ Irrigation J� Process O
Assembly Type: Reducad Pressure ❑ Double Check ❑ Pressure Vacuum Breakerff (Other.
it
Mfg.: FA 6 c t7 Model No.: 65 - I Size: 1 Serial No.: -4 o O
Date Installed: Last Inspection: -T—OpA Line Pressure:3K 1j.4 PSI
Location: F tt i:. c i dy- n F
Initial Test Result
Cotntnents
Re -Test Results
Ti mess OitFerential
Tightness Dithrential
Check No l
Leak �
Leak
RP, DC, PVB
Tight 1
Tight
Check No 2
Leak
8
Leak
(RP, DC
Tight
Tight
Relief Valve
Buffer
PIP
Air Inlet
PVB
1.3
Shut-off valve No. i Leak ❑ Tight
Shut-off valve No. 2 Leak ❑ Tight in
z
Repairs/Comments:
Assembly MnMnleal Test: Passed Failed
Technician certifies this assembly has been tested in accordan with ABPA Procedures: YES
Tester Name: PHILIIP T. MURPHY A Certification No.: _06-OMS Expires: 31 December 2006
Tester Signature: - Test Date 2 - D 5 Time: // - S,.S
Tester Phone: (970) 91i18-7263 est auge: Prime 226 098982 Gauge Re-Cert Date: May 2, 2006
Teebniclao Signature:
Signatutc ltMicao m verification by Sipwx that isolation valves were m limed to pre -test orientation,
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