Laserfiche WebLink
BACKFLOW PREVENTION DEVICE TEST REPORT <br /> SERVICE ADDRESS�l E i. N ��s_L _ ___METER NO CITY n=Yi' <br /> LOCATION OF DEVICE A&lr-1 e -rot,44 <br /> CUSTOMER / -, / DEVICE INFORMATION <br /> S 7 Aw .0 �IJiL�Y! KG'✓+1+� 62 v/C_ TYPE <br /> DOUBLE CHECK ❑ SIZE. �y MFR <br /> ie CQ <br /> j 1pl �. y0 REDUCED PRESSURE <br /> PHONE O. 7_�n.g 3 6 g�y7G PRIES VACUUM BREAKER <br /> MODEL NO.��s SERIAL NO. L�! <br /> REPORT OF TEST RESULTS <br /> REDUCED PRESSURE DEVICES PRESSURE VACUUM BREAKER <br /> DOUBLE CHECK DEVICES RELIEF AIR INLET CHECK VALVE <br /> 1st CHECK 2nd CHECK VALVE OPENED AT <br /> CLOSED <br /> psi TIGHT ❑ <br /> INITIAL DC - CLOSED TIGHT)pt CLOSED TIGHT) OPENED AT DID NOT <br /> TEST RP' A1C? psid LEAKED ❑ 0,-5psid OPEN ❑ LEAKED ❑ <br /> LEAKED ❑ <br /> REPAIRS <br /> AND <br /> MATERIALS <br /> USED <br /> TEST DC ' CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT OPENED AT CLOSED TIGHT❑ <br /> AFTER RP' psid psid psi <br /> REPAIR q <br /> INITIAL TEST BY,L'l raj" f CERTIFIED TESTER NO ��6 S DATE <br /> FINAL TEST BY CERTIFIED TESTER NO. DATE <br /> COMMENTS: <br /> BILL HROVAT <br /> CERTIFIED BACKFLOW THE ABOVE REPORT IS <br /> PREVENTION DEVICE TESTER <br /> "„65 CERTIFIED TO BE TRUE <br /> OFFICE (209)334-4640 <br /> CELL(209)327-3971 <br /> FAX(209)367-1914 <br /> SIGNATURE DATE <br /> Lodi,California ”- <br /> ALL TYPES-ANY LOCATION <br />