BATreport 8235 Talbot Rd.pdfBACKFLOW PREVENTION ASSEMBLY TEST REPORT
ALWAYS TESTING INC.
6501 227th St. SW, MOUNTLAKE TERRACE, WA 98043
(206) 718-8378 (425) 672.4345
ACCOUNT # 190
NAME OF PREMISE Cheryl Arford _
SERVICE ADDRESS 8235 Talbot Rd, CITY Edmonds
CONTACT PERSON Cheryl
LOCATION OF ASSEMBLY In BoilerRoom
Commercial ❑ Residential
PHONE 425 640 - 3352
ZIP 98026
DOWNSTREAM PROCESS Residential Boiler DCVA ❑ RPBA ® PVBA❑ OTHER
NEW INSTALL ® EXISTING= REPLACEMENT ❑ OLD SER # PROPER INSTALLATION? YES X No ❑
MAKE OF ASSEMBLY Cor) br4e_C2 MODEL qi9,;?0 T;-- SERIAL NO. 1.Z1'636 SIZE 1, it
AIR GAP INSPECTION: Required minimum air gap separation provided? YES ❑ NO ❑ Detector Meter Reading
REMARKS: New Installation LINE PRESSURE PSI
CONFINED SPACE? No
TESTERS SIGNATURE CERT. NO. 3822 DATE 3/3/2008
TESTERS NAME PRINTED Darin Schnee TESTERS PHONE # 206 718-8378
REPAIRED BY DATE
FINAL TEST BY CERT. NO. DATE
CALIBRATION DATE 8110107 GAUGE t 09061793 MODEL 845-5 SERVICE RESTORED? YESJ�NO ❑
I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment
DCVAIRPBA
DCVAIRPBA
RPBA
PVBA/SVBA
INITIAL
CHECK VALVE NO. 1
CHECK VALVE NO. 2
OPENED AT J2� PSID
AIR INLET
TEST
LEAKED ❑
LEAKED ❑
OPENED AT
PSID
#1 CHECK 2i • ! PSID
PASSED
PSID
AIR GAP OK? VeS
DID NOT OPEN
❑
FAILED ❑
PSID
L����+ fr
CLEAN
REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
NEW
❑
❑
❑ ❑
❑ ❑
HELD AT
PSID
PARTS
❑
❑
❑ ❑
❑ ❑
LEAKED
❑
AND
❑
❑
❑
❑ 0
REPAIRS
❑
❑
❑ ❑
❑ ❑
CLEANED
Li
REPAIRED
❑
TEST AFTER
LEAKED ❑
LEAKED ❑
OPENED AT PSID
AIR INLET
PSID
REPAIRS
PASSED ❑
FAILED ❑
PSID
PSID
#1 CHI=CK PSID
CK VALVE
PSID
AIR GAP INSPECTION: Required minimum air gap separation provided? YES ❑ NO ❑ Detector Meter Reading
REMARKS: New Installation LINE PRESSURE PSI
CONFINED SPACE? No
TESTERS SIGNATURE CERT. NO. 3822 DATE 3/3/2008
TESTERS NAME PRINTED Darin Schnee TESTERS PHONE # 206 718-8378
REPAIRED BY DATE
FINAL TEST BY CERT. NO. DATE
CALIBRATION DATE 8110107 GAUGE t 09061793 MODEL 845-5 SERVICE RESTORED? YESJ�NO ❑
I certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment