HomeMy WebLinkAbout6127 TILDEN ST - SPECIAL INSPECTIONS - 5/14/2004SCA022-6-+-
ALPS MECHANICAL N 970-5814317
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Customer must retain a copy of this report for a minimum of three years
Water District/Authority: Qoffa,-c,
Service Name:
u ron.�•• .P
Service Address: `T
Contact Person:_Title: T,�r„,`� f PhoneL(a7{j_l`1Co1—
Owner/Mgmt Co/Contractor:
Mailing Address:
Contact Person: Title
Phone
New ®. Existing❑ Replacement For:
Use: Domestic ❑ Fire ❑ Irrigation Q
Assembly Type: Reduced Pressure ❑ Double Check ❑ Pressure Vacuum Breaker13 Other
Mfg.: Model No.: Size: Serial No.:
Date Installed: ,5 _ �. Last Inspection: Line Pressure: -Al PSI
Location: _ .) e9 a r _ i d n 4 kpi,
Initial Test Result
Comments
Re -Test Results
Tightness Diffetial
ren
Tightness Differential
Check No 1
Leak
Leak
RP, DC, PVB
Tight
8 t •
Tight
Check No 2
Leak
8
Leak
(RP, DC)
Tight
Tight
Relief Valve
s.
;
j.
Buffer
RP:.
Air Inlet
PVB
p�
z"- ,
` 0(.
1 Leak ❑ Tight Id
Shut-off valve No.
L
Shut-off valve No. 2 Leak ❑ Tight
ASSE TEST USED: 5010-1013-1 5010-1015-2 5010-1020-1 _g_ 5010
Repairs/Comments:
Assembly Mechanical Test: Passed Failed ❑
If mechanical test fails, the Water Purveyor/Authority must be notified immediately
ly and repairs made as soon as possible
Technician certifies this assembly has been tested in accordance with ASSE Procedures
Tester Name: Dennis Alvs Certification No.: 1811 Expires: 711S104
Tester Signature: Test Date: s— -_ "�� Time; _ , ' .
Tester Phone: 970-581-4317 Test Gauge: WATTS TK99E Gauge Re-Cert Date: 5/1/04