HomeMy WebLinkAbout6244 WESTCHASE RD - SPECIAL INSPECTIONS - 5/27/2004'eb�Am �,-A9
airs MEcBarncai, - 970-581.4317
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Customer must retain a copy of this report for a minimum of three years
Water District/Authority: F4 L ,p,(4 K r - Lag C. /6uc4
Service Name:
Service Address:
Contact Person: A 10L,,A, Title: 0,04.-f i : Phone: /- 7-q- 3VcI6
Owner/Mgmt Co/Contractor:
Mailing Address:
Contact Person: Title
New ® Existing❑ Replacement For:
Use: Domestic ❑ Fire❑ Irrigation 18
Phone
Assembly Type: Reduced Pressure ❑ Double Check ❑ Pressure Vacuum Breaker® Other.
Mfg.: Fe bon Model No.: 7l5 Size: Serial No.: ( d. <1 n
Date Installed: S_o Last Inspection: Line Pressure:—�-! </�C PSI
Location: � � 4 _r 4 zp p .fit pii,c
Initial Test Result
Comments
Re -Test Results
Ti tness Differential
Ti htness Differential
Check No 1
Leak ®
Leak
RP, DC, PVB
Tight
•
Tight
Check No 2
Leak
Q
Leak
(RP, DC)
Tight
Tight
Relief Valve
.,
R,
i;
Buffer
_-
RP
Air Inlet
�ws?
PVB
2
Shut-off valve No.
I Leak ❑ Tight a
Shut-off valve No. 2 Leak ❑ Tight
ASSE TEST USED: 5010-1013-1 5010-1015-2 5010-1020-1 x 5010-
Repairs/Comments:
Assembly Mechanical Test: Passed ® Failed ❑
irmechanical test fails, the Water Purveyor/Authority must be notified immediately and repairs made as soon as possible.
Technician certifies this assembly has been tested in accordance with ASSE Procedures
Tester Name: Dennis Alps Certification No.: 1811 Expires: 7115/04
Tester Signature Test Date: - S -a1-01 Time: 7,'
Tester Phone: 970-581-4317 Test Gauge: WATTS TK99E Gauge Re -Cent Date: 5/1/04