HomeMy WebLinkAbout6802 ENTERPRISE DR - SPECIAL INSPECTIONS - 3/7/2019METCO LANDSCAPE, INC.
0
2200 Rifle Street • Aurora. Colorado 80011 a (303) 421-3100 • Fax (30) 421-1120
Assembly Serial #:
y
Test Date/Tme: !7
1
Gauge Serial #:
District Required Info:
Tester Certification #:
d
Date Certification Expires:
1pc� ' A /
Assemblv Test Results: L4'FASS n FAIL
Backflow Prevention Device Test R Maintenance Report �I
(please print and submit completed copy within 10 days of the test) 1
Water District Authority: Account: Contact Person:
o Facility Name: -rk;- ! CS �� 1 L /i /� /�i -� 57 /2' Gi D Phone:
°i
%Contact
Service Address: 1 )'� y L i t✓ ✓i t; S / �` VT�%J�, ,�'r r e.5' �� jy
Mailing Address:
U ❑ Owner ❑ Manager ❑ Contractor ❑ Other Contact Person:
pCompany
Name/Title: Contact Phone:
Mailing Address:
Make: Model:_ &- Size: y�
Type: ❑ RPZ ❑ DC , ' VB ❑ SVB ❑ Air Gap ❑ AVB ❑ Other Device
Date Installed: Location on Property: /tf%/TiG /i�=L f' er/lGI✓%
E
❑Replacement Device Orientation Service Protection
Previous device serial # lnlet:� Outlet: El Domestic El Containment
Q Vertical Up ❑ ❑ Fire_ — .r Isolation
New Installation
❑ Vertical Down Irrigation ❑ Containment by Isolation
,❑, r/
❑ Stolen ❑ Horizontal ❑ Other:
Line PSI: '
Initial Test Results:
Repaired:
❑ Ck#1 ❑ Ck#2 ❑ RV
Cleaned:
❑ Ck#1 ❑ Ck#2 ❑ RV
Re -test Results
adf
Tightness
Differential
Tightness Differential
Check V ve 1
❑Lek
J z4
Ck#1
❑ Leak
RPZ, D , PVq, SVB
E fight
❑ disc ❑ spring ❑ seat ❑ other:
❑ Tight
Check Va a #2
❑ Leak
Ck#2
❑ Leak
RPZ, DC
❑ Tight
❑ disc ❑ spring ❑ seat ❑ other.
❑ Tight
rii
Relief Valve
RV
RV RPZ
❑ diaphragm ❑ seat ❑ other:
m
Buffer
Repaired:
❑ Air Inlet
Cleaned:
❑ Air Inlet
m
Air I �^^''��
Air Inlet, rV6 SVB
C, +
Air Inlet
❑ poppet ❑bonnet ❑other.
y
Shuto alve #1
❑ Leak qqh>
SOV #1: Lj open Upon Arrival Ll Open At Departure
Back pressure exists? Lj YES I-O
F�
Shutoff Valve #2
' i
Lj Open
Leak
ht
ISOV #2: Upon Arrival Open At Departure
Cause
Assembly Concerns:
(only if applicable)
TesYProcedure:
ggPA
Comments:
C & J e7l
❑ Incorrect
2 ❑ ASSE
Installation
❑ Incorrect Use
Z1IL-oV&-iD J-,^i `�Ly�r /� /
Turnoff date:
Turnoff date:
/�3f A.)C-J S�/ l�G�
Turn off time:
Turn off time:
a)
Alarm Company/Fire Department Notified El Fire suppression contract certification #
'o
Person Notified: Contacted by:
Z
Turn off date/time: Turn on date/time:
Y
Test Kit Make: �%d �f( Model: O 5 Last Calibration Date: Imo%
b
I hereby car* that the isolation/shutoff Values (50V #i and SOV #2) have been returned to the position in which they were found and that the last test was done according to the
procedure shown required by, th Water OistdcdAuthodty shown above) and the test readings are true and accurate to the best of my ability.
LrrJ J
r
m
m
�n�r
(please print) ,�}%tiC ' J?i 3 _ (please print)
Testing Company: Phone: sr/J�/23/23CustomerNPhone:
(please
print) ny
Tester Name: Y6'//!7AL✓ Tester Signature j//,�lr/L /% �c
ustomerSignature:
Backflow testers who test or repair assemblies on a fire line must be registered with the Colorado Division of Fire Safety.