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QUALITY SERVICE, INC 299-838-7842 <br /> BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br /> WATER CUSTOMER MAILING ADDRESS ASSEMBLY INFORMATION <br /> NAME: St. Francis Yacht Club RP 11. Febco <br /> TYPE SIZE MFG <br /> ADDRESS: 94344 W. Tinsley Island River Route 825Y BG1621 <br /> ciTy,sTATE,zfP: Stockton, CA 95219 MODEL SERIAL# <br /> SERVICE ADDRESS: ASSEMBLY LOCATION: <br /> Saler Pond <br /> CITY,STATE,ZIP: WATER PURVAYOR: INSIDE BUILDING: <br /> DOUBLE CHECK VALVES PRESSURE TYPE <br /> REDUCED PRESSURE ASSEMBLY VACUUM BREAKERS <br /> CHECK CHECK PRESSURE RELIEF AIR CHECK <br /> VALVE#i VALVE#2 VALVE INLET VALVE <br /> INITIAL CLOSED TIGHT CLOSED TIGHT CLOSED TIGHT <br /> 75-.__ _� 3 <br /> HELD AT(PSID) HELD AT(PSID) OPENED AT(PSID) OPENED AT(PSID) HELD AT(PSID) <br /> n <br /> OPENED UNDER 2.6 PSID ^^ OPENED UNDER 1.0 PSID <br /> TEST LEAKED LEAKED �-+ DR DID NOT OPEN ]--1 OR DID NOT OPEN El LEAKED El <br /> 1.CLEANED E3 1.CLEANED Ij 1.CLEANED ❑ 1.CLEANED ❑ 1.CLEANED <br /> R 2.EXERCISED <br /> E REPLACED: REPLACED: REPLACED: REPLACED: REPLACED: <br /> P 2.DISC 0 2.DISC Q 3.DISC(S) r] 2.DISC ❑ 2.DISC E] <br /> A 3.SPRING 13 3.SPRING p 4.SPRING p 3.DIAPHRAGM J] 3.SPRING <br /> 1 4.GUIDE r] 4.GUIDE ❑ 5.DIAPHRAGM(S) E] 4.FLOAT E] 4.GUIDE <br /> R S.SEAT n S.SEAT p 6.SEAT D S.SPRING j] 5.SEAT <br /> S 6.MODULE E3 6.MODULE L] 7.O-RINGS(S) ❑ 6.OTHER 6.MODULE �] <br /> 7.OTHER 13 7.OTHER ❑ 8.MODULE ❑ 7.OTHER j] <br /> 9.OTHER 17 <br /> FINAL CLOSED TIGHT K3 CLOSED TIGHT �] CLOSED TIGHT <br /> TEST (RP)PSID (RP)PSID OPENED AT PSID OPENED AT PSID PSID <br /> THE ABOVE REPORT IS CERTIFIED TO BE TRUE PASSED E FAILED <br /> TIME OF INITIAL TEST _ TIME OF FINAL TEST <br /> START END START END <br /> INITIAL TESTAHY FINAL TEST BY <br /> CERTIFIED TESTER NUMBER CERTIFIED TESTER NUMBER <br /> NUMBER DATE NUMBER DATE <br /> SYSTEM PRESSURE: <br />