HomeMy WebLinkAbout1729 E 4th St - EngineeringBackflow Assembly Test Repo~ Received
~ ~ City of Pon Angeles
~r~s ~* Public Works and Utilities Depa~ment
Water~astewater Collection Division
SERVICE ADDRESS: '
Ma~ufac~rer Model Size Serial
1S THIS AN ~PROVED ASSEMBLY? ~S ~0 B IS ASSEMBLY ~STALEED CORRECTLY'? YES ~'~O B
DATE OF INSTALLATION
REDUCED PRESSURE PRINCIPLE ASSEMBLY RP ~ RPDA
DOUBLE CHECKVALVE ASSEMBLY sv~ B av~
CHECK VALVE ~1 CHECK VALVE ~2 RELIEF VALVE PVB/SVB
Repairs Cleaned ~ Cleaned ~ Cleaned ~ CHECK VALVE
REPAIRS
Cleaned
Details
Final Closed Tight ~ AIR INLET Opened al psi
~, r} CHECK VALVE Held at ps~
AIR GAP INSPECTION:
REQUIRED MINIMUM SEPARATION: YES ~ NO ~ TYPE OF HAZARD ~" f;
Line Pressure ' psi
COMMENTS
g2 Shutoff Held YES ~ NO
Relief Valve Exercised YES ~ NO
Date Time T~te~ Si~ature Cch. ~ Test Kit Passed Failed