HomeMy WebLinkAbout3235 MUSKRAT CREEK DR - SPECIAL INSPECTIONS - 7/25/2009JUL-28-2009 TUE 07:46 AM FORT COLLINS UTILITIES
9704162442 P. 06
Assembly Test Results Pass ❑ Fall
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;a Water District/ Authority: c 11AS Account: Contact Person:
Facility Name: Phone # :
` YService Address:y 0-L ec- rtWE �MlhS 70-3
Mailing Address: '
Owner o Manager o Contra Other Contact Person: L14 IT
< Company Namel Titre: et eo
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Mailing Address: a✓wl�� o U 6 l(y.
Make: Model: WSize:
;.�.;. Type: RPZ ❑ DC �PVB SVB , Ajr Gap DAVB DOther
Date Installed: Location on Property:aS r d
JE-1(Only if Appmbte - Indude Previous SwWW) Orientation Service Pmtection
y R o Replacement Assembly f►tleC Outrat o Domestic o Containment
'Nevlf Installation gQ�f r�3 1 Vertical Up 1 Fire o Isoiatlon
Pr;11-y 0 o
- Vertical Down o Containment Stolen r
r Previous Assembly Serial # o -► Horizontal -+ o Other By Isolation
Line PSI: Ini I lei Test Results_ Repaired: i Cleaned: Re -Test Re -Test Results
Tighfn DifF ntiall amo cm, Rvo CWn CkM RVo Tightness Differential
=;
i.:
Check Valve # f o Leak ` : CW1 o Leak
M
(cam+: RPZ .eve) V(Tight '. 1 cftm Wngo Moto 0"W.. o Tight
S'
Check Valve l� —'
'a Leak ' � o Leek j
(00M RPZ DC) ' o Tight i disco sprtrtgo aeato Coley. o ht
'$
Relief Valve RV I
'I
Buffer Repaired: , Cleaned:
(R'Z) ! Air Inlet n Air INefG ( i
---
,;
Air Inlet air adet
;.�(PW
Inlet PV%M) I '
poppet o bonnets. other:
Shutoff Valve #1 ; o Leak Tight l SOv aF1 Open upon ARiva! n Open upon Departure: o BKWMWM B ift? Yes ❑ tVo
Shutoff Valve #2 o teak Tight j SOV sZ Open Upon ft" apen OUpon Departure: o Ceusq
Assembly Concerns- I ure: ,Comments: —
::° (oMy if awkable) ;
~` 1I Inaormt InsUftion? a !ASPA o ASSEX
f i mooned Use ?
_ _....... ,_
- r Tum Off Date Tum On Date:
?° ITum Oft Time• Tum On Tone:
`Alarm ComPanyfRre Department Notified:
Parson Notified: Contacted By.
Turn Off DateMme: Turn On DateMme:
Test Gauge Make: ; Model:-97.- Last Calibration Date: 62 / 7 /
;4 I hereby Cart ly that the 1e0180on / Shutoff Valves (SOV91 and SOV 82) have bean not e d to me P � v�ch �Y Were found �d � the test was done a000rdrrq b the
Mood" 611011fr1 ab0'191@QUUId by life Wafer DistrieU
"-"t " d�� above; mod the jW f o*W ale role and acosel a to the bad of aV �Iy.
t I
i"ITeaftCompanyL�iil�J,y. �C. `� 1 vV(_ Phones I.�7�5�. '�JCAntomw Name:
Phones:
Tester Name: ��;; 1 nq
(Gllstwer)
Signature: Slanaturn-
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