HomeMy WebLinkAboutPermit File BLD-2020-0137 2720 Geer Lane (8)Sam RAILROAD AVENUE
q��il1 MOUNI VERNON, WA 99273
FAX I WI 42LF9Napl aaa a114
Siallie
BACKFLOW PREVENTION ASSEM13LYTEST. REPORIN
plumbing&heating
TEST DUE DATE! !!Y� FORWARDED TO:
Nameof Premise: 9
.�lU
Service Address: r,Ga
Mailing Address:
1 �c IU s J� oC ton !x
Location of Assembly:
Cross -Connection Control for:-
� 5560
f iNI� STrid No.
Device: Model
Manufacturer
lip ;DCDA �
REDUCED PRESSURE PRINCIPLE ASSEMBLY DC pCg ❑ Air CI "GRPDA El
Gap ❑
SVB ❑ PVB
DOUBLE CHECK VALVE ASSEMBLY Relief Valve PVB/SVB
Check Valve #1
Check Valve 92 AIR INLET eked ,❑..,/ Leaked ❑ Did not open ❑ Did not opm ❑
INMAL Closed Tight l Closed TiOt PSID
Opened u PSID peened LL
TEST_ PSID CRECK VALVE
PSID Held at
Held az Cleaned ❑ Leaked ❑
Cleaned Replaced ❑ - Cleaned ❑ Replaced ❑ Held LL PSm
REPAIRS Replaced ❑ Cleaned ❑
R laced ❑
Alit INLET
Opened a PSID
DETAILS - _. -..
TT11 ---CEIECKVALti'E
_
PSID
t_IJ_ HeIdLL�
_ _ Closed Tigh � 0— PSID
- — Closed Tight .j,
FINAL PSID Held at_�Psm 66 PS S
TEST Held at Line Prtssore:--�
Replacemene ❑ Old Serial No.:��— _
Existin6: � Detehor Meter Reacting: �� ❑
New install ,,, Yee: ❑ Na:. - Ili' No:
AIR
GAPMSPECTION: u►'^'!�°""tl'°r��r to this a proper Installation? Yn: i
Parsed Palled ❑
Comments: 111 GCS"
Serial No: -77c) CA
o a Model: Tester Phon
Calibration Date.
e# 7 Dar.
GlCerL No.
Taster Signature. 5} 1+4/�
Tester Name: Datr.—
CerLNo. -- t
Repaired BY:
ad 1 have used WAC 246-290A96eppmved test methods and ten eq°'P
Final Test BY: 11
1 aeuify
Nd this capon is eceorde,