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BACKFLOW*REVENTION DEVICE TIAST REPORT <br /> SERVICE ADDRESS f lG&a IV,, -*� METER NO CITY r" <br /> LOCATION OF DEVICE � ''� ' e"-11? 4!�"C--e <br /> c sToS ��A �// PE DEVICE INFORMATION <br /> TY!� Z DOUBLE CHECK ❑ SIZE. .+� MFR <br /> REDUCED PRESSURE <br /> PHONE NO. 6 g Y`7PRES VACUUM BREAKER ❑ MODEL NO. 2"Q' SERIAL NO. 'Ec9ay <br /> -2 Z <br /> ('2nl r�EPORT 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 tj <br /> INITIAL DC " CLOSED TIGHT o CLOSED TIGHT ❑ OPENED AT DID NOT <br /> TEST RP * psid LEAKED ❑ ZI Fr' psid OPEN Q <br /> LEAKED <br /> LEAKED ❑ <br /> c- k l <br /> + <br /> , 4 <br /> REPAIRS <br /> AND <br /> MATERIALS <br /> USED <br /> TEST DC `CLOSED TIGHT CLOSED TIGHT OPENED AT OPENED AT <br /> AFTER RP • jrJ psid CLOSED TIGHT E <br /> REPAIR �, psid psi <br /> INITIAL TEST BY CERTIFIED TESTER NO /M-7 DATE <br /> FINAL TEST BY __/ l / YIJy _ CERTIFIED TESTER NO. ¢�+ DATE <br /> COMMENTS: <br /> BILL HROVAT <br /> CERTIFIED BACKFLOW THE ABOVE REPORT IS <br /> PRE=VENTiON DEVICE TESTER <br /> #1165 CERTIF ED TO BE TRUE <br /> OFFICE (209) 40 <br /> CELL(209)327-397'7-397 1 <br /> FAX(209)367-1914 <br /> Lodi,Califomia SIGNATURE, DATE <br /> ALL TYPES-ANY LOCATION <br />