HomeMy WebLinkAbout1133 NASSAU WAY - SPECIAL INSPECTIONS - 9/9/2004SEP-09-2004 THU 09:03 AM FORT COLLINS UTILITIES 9704162442
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Test Address:
Sam & Gayle Knight
1133 Nassau Way
Fort Collins CO
BACKFLOW TEST REPORT t INVOICE
Bill To: WaledM
1216 N. Shields
Fort Collins CO 80521
Test Date 9/312004 Time 4:25 PM
Supplier Fort Collins/l-ove...
Installation New
Permit# B04045289
Location E. Side
Manut. Feboo
Model 765
Size 1"
Sedel# H082236
Usage Isolation
ASSEAM" PVB-5010-1020-1
Mechanical Test Passed
A Certified Tester 545-1361
Kerrie Hilgefort
Certification #:1812
Guage: Watts TK99E
Amount Due
267-8994
Line (P) 60
PVB Inlet 2.6
PVB Check 2.2
RP Relief
RP 1
RP 2
RP Buffer
DC Check 1
DC Check 2
DC /so. 2
Plesss make cheeks payable to: ACT or A Cer#W Tester 3113 Conestoga CL Fort Collins, CO 80526
Please keep this report on file for 3 years. Remit nothing with payment unless the lest address is not noted on your check.
Thank Yout