COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

HAMPTON'S BACKFLOW SERVICES BACKFLOW PREVENTION DEVICE TEST REPORT WILKINS 975XL 1" 2430689 MAKE MODEL SIZE SERIAL NUMBER ID NUMBER Assembly location: Inside the sewage treatment plant on the west side of the park. (hose bib) ❑Temporary ® Permanent ❑New, old SIN Pressure PSI Billing Country Squire Mobil Estates Device Country Squire Mobil Estates Address: 4350 Cherokee Rd. Address: 4350 Cherokee Rd. Stockton,CA 95215 Stockton,CA 95215 Phone 4 (93 -1505) Test method, ® RP ❑ SVB REDUCED PRESSURE PRINCIPAL ASSEMBLY ❑ DC ❑DCDA 9th Edition ❑ PVB ❑RPDA lJ5C DOUBLE CHECK VALVE ASSEMBLY Check Valve#1 Check Valve 42 Relief Valve PVB 1 SVB Air Inlet opened at Die INITIAL Held at r �0 PSID Held at PSID Opened at ! -7 PSID ❑not TEST PSID Closed Tight open ❑ Leaked ❑ Leaked ❑ Did Not Open Check Valve held at PSID ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Clean REPAIRS ❑ Replaced ❑ Replaced ❑ Replaced ❑ Replace ❑ Disc ❑ Disc ❑ Disc ❑ O-Ring ❑ Disc Holder ❑ Disc HoldeQ ❑ Disc Holder [:] Air Inlet Disc ElSpring ❑ Spring f E] Air Inlet Spring El0-ring ElO-ring ❑Xing ing ❑ Check Disc ❑ Module ❑ Module ❑ Diaphragm ❑ Disc holder ❑ Other ❑ Other ❑ Bellows ❑ Check Spring ❑ Other ❑ Other FINAL Held at PSID Held at PSID Opened at PSID Air Inlet PSID TEST Check Valve PSID Closed Tight El (RP) Comments: INITIAL Date: ''ff rr Certified Tester No. TEST (rady) �f " t 1 10872 Passed ❑ Failed To y: Print Name: Time )VIO PAUL HAMPTON Date: Certified Tester No. REPAIRS bndy) 1.0872 Repair>3y: Print Name: 77T Time PAUL HAMPTON FI.N'AL Date: Certified Tester No. TEST (may) 10872 ❑ Passed ❑ Failed Test By: Print Name: PAUL HAMPTON Time HAMPTON'S BACKFLOW SERVICES Authorized By: 888-776-6105