HomeMy WebLinkAbout3317 ROOKERY RD - SPECIAL INSPECTIONS - 10/25/2002C1
6124 S. College Avenue
A ( Fort Collins, Colorado 80525
SpRlNktERMIR, INC. (970) 223-4588 • Fax (970) 2
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BACKFLOW PREVENTION ASSEMBLY
TEST & MAINTENANCE_RTPORT
Stallation: Newy
Service Name
Service Addres ail
Mailing Address
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Contact Person
Assembly Makee
Location on Property -,fix
Water Supplier I
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TEST FOR DOUBLE CHECK AND REDUCED PRESSURE ASSEMBLIES
(Direction of Flow: Check #i 61 psid Check #2 i . d psid Relief Valve
ccak Tightness: Check #1 TightLead .�,. Check #2 Tigh[ x Leak
TEST FOR PRESSURE VACUUM BREAKER
Check Valve psid Leak Tightness: Tight Leak- Air Net
REPAIRS AND COMMENTS
Li ,'ass ✓ Fail ne Pressure �jh Q��i
' IS TESTER CERTIFIES THIS ASSEMBLY MEETS MINIMUM STATE AND LOCAL SPECIEI<
Tsted B &1avMV_14� i Certification # l
Gauge Type Pro Master - Differential Last Gauge Calibration Date
mate of Test 1 d -9 S - b� Tune of Test Tester Phone N
Tester Signature � � A Owner or Agent Signature
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WHITE COPY - OWNER
YELLOW COPY - WATER
PINK COPYIF
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