HomeMy WebLinkAbout6127 WESTCHASE RD - SPECIAL INSPECTIONS - 8/26/2004ALPS MECHANICAL N 970-581-4317 F/-'o 44 -0 4-9 9(
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Customer must retain a copy of this report for a minimum of three years
Water District/Authority:
Service Name:�—
Service Address: `6, f ml
Contact Person: _ l_ AL jtTitle:-'r (r Phone _ 7 �l t�► �_
Owner/Mgmt Co/Contractor:
Mailing Address:
Contact Person:
Phone
New ® Existing ❑ Replacement For:
Title
Use: Domestic ❑ Fire ❑ Irrigation (a
Assembly Type: Reduced Pressure ❑ Double Check ❑ Pressure Vacuum Breaker& Other
Mfg.: Model No.:��� Size: 3`1/ Serial No.:
Date Installed: Last Inspection: Line Pressure04 s�L_ PSI
Location: =�r �f� ;2f 6 ",
r�
ASSE TEST USED: 5010-1013-1 5010-1015-2��_ 5010-1020-1 5010-__
Repairs/Comments:
Assembly Mechanical Test: Passed Failed ❑
If mechanical test fails, the Water Purveyor/Authority must be notified immea ate y 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: 1�15�4
Tester Signature: Test Date. .. Time:
Tester Phone: 970-581-4317 Test Gauge: WATTS TK99E Gauge Re -Cent Date: 5/1/04