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_/5/2020 05 : 20 PM PST 70 : 12094640138 FROM : 2092532090 Page : 3 <br /> A I91of P City of Ripon <br /> Public.Works Department <br /> 259 N. Wilma Avenue <br /> CITY-OF RIPON Ripon,Ca 95366 <br /> (209).599-2151 <br /> arareaBACKFLOW PREVENTION DEVICE Fax P_09)599-2183 <br /> TEST REPORT <br /> Owner Name/Address: Service Name/Address: <br /> Ripon Unified School District Colony Oak School 2 <br /> 304 N. Acacia Ave. CA 95366 22241 S. Murphy Rd. CA 95366 <br /> Manufacturer WILKINS Model 375AST Size 4 Serial # 11143 <br /> Device Location By the tank.South device. <br /> ❑ New Device ❑ Temporary ❑ Replacement - Old Serial# <br /> Reduced Pressure Principle Assembly RP ® DCDA ❑ <br /> DC ❑ RPDA ❑ <br /> Double Check Valve Assembly SVB ❑ PVB ❑ <br /> Check Valve#1 Check Valve#2 Relief Valve PVD/SVB <br /> J 2 2 <br /> i Held atVp PSID Held at PSID Opened at J•7 PSID AIR INLET <br /> Z W p� <br /> Leaked ElClosedTight K Opened at PSID <br /> Leaked ❑ Did Not Open ❑ Did Not Open ❑ <br /> ❑ <br /> 0 Cleaned ❑ Cleaned ! ❑ Cleaned CHECK VALVE ❑ <br /> =' ❑ :Replaced ❑ Replaced ❑ Replaced Held at PSID <br /> a, ai Disc <br /> Disc Disc ❑ Cleaned <br /> — — <br /> t Spying Spring — Spring <br /> — Guide Guide Diaphragm m ❑ Replaced with: <br /> P <br /> (n E — Seat Seat Seat Type: <br /> Module Module — <br /> Q � Module Mfg <br /> W Q — O-Ring O=Ring O-Ring <br /> Other Other g <br /> — Other <br /> a Closed Tight ❑ Closed Tight ❑ Air Inlet PSID <br /> Z � <br /> LL N PSID PSID Opened at PSID Check Valve PSID <br /> Comments: <br /> NDate _ �- .,20 Timeertif Tester No. 10872 ❑Failed <br /> © .Passed <br /> A Paul Ham tan <br /> F Teste i 8y(Signature) .:. Print:Nam0 p <br /> oh Date Time Certified Tester No. 10872 <br /> - <br /> � Repaired By(Signature) print Name Paul Hampton <br /> Date: Time Certified.Tester No. 10872 ❑Passed❑ Failed' <br /> Gn.E" Tested:By(819nature) Print Name Pagl,Hampton. <br /> Received Time Jai), 5. 2020 5 : 18PM No. 5772 <br />