Willowdale - Backflow report.pdfAACRA Backflow Testing and Repair, Inc, BACKFLOW PREVENTION ASSEMBLY TEST REPORT
(360) 660-1117 Test Procedure.- USC 10th Edition
WATER PURVEYOR Edmonds Public Works ACCOUNT #
ASSEMBLY ID/FILE #/UTILITY DEVICE # Meter #
NAME OF PREMISE Willowdale Townhotnes Commercial [VI Residential ❑
MAKE OF ASSEMBLY Febco
MODEL. 850
SERIAL NO. HC39623 SIZE .75"
DCVA / RPBA
DCVA / RPBA
RPBA
PVBA / SVBA
INITIAL
CHECK VALVE
NO.]
CHECK VALVE NO.2
I
ATR INLET
TEST
OPENED
CLOSED TIGHT❑
CLOSED TIGHT ❑d
OPENED AT
PSID
PASSED ®#1
LEAKED
❑
LEADED F-1
CHECK PSID
DID NOT OPEN
FAILED ❑
2.8
PSID
3.0 PSID
AIGAP OK?
AIR
CLEAN REPLACE
PART
CiEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
NEW
❑ ❑
❑ ❑
❑ ❑
HELD AT
PSID
PARTS
❑ ❑
❑ ❑
❑ ❑
LEAKED
❑
❑ ❑
❑ ❑
i❑ ❑
AND
❑ U
❑
❑ ❑
CLEANED
REPAIRS
REPAIRED
❑
TEST AFTER
CLOSED TIGHT
❑
CLOSED TIGHT ❑
RV EXERCISED ❑
AIR INLET
PSID
REPAIRS
LEAKED
❑
LEAKED ❑
OPENED AT PSID
PASSED ❑
FAILED
PSID
PSID
#1CHECK PSID
CHK VALVE
PSID
❑
AIR GAP INSPECTION:
SUPPLY
PIPE
DIAMETER
SEPARATION
PASS ❑ FAIL
❑
DETECTOR METER READING
LEFT SERVICE AS FOUND Isolation valve: Open Evj Closed ❑ SOV#1 Open ❑ Closed Ev] SOV#2: Open ❑ Closed d❑
REMARKS:
TESTERS SIGNATURE:
LINE PRESSURE 61 PSI CONFINED SPACE? No
CERT. NO. 85601 DATE 1/21/2013
I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.