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BACKFLU. PREVENTION DEVICE TEST R_?ORT <br />■ t <br />< !( ; ■cnvMETER NO. SERVICE ADDRESS <br />LOCATION OF DEVICE <-C <br />TYPE:SIZE <br />SERIAL NO,DOUBLE CHECK <br /> REDUCED PRESSURE <br />PHONE NO.^.PRES. VACUUM BREAKER Q <br />REPORT OF TEST RESULTS <br />Reduced Pressure Principle Assembly <br />Double Check Valve Assembly <br />#2#1 <br />PSI-PSI <br />PSIDOPENED AT 1. CLOSED TIGHT <br />DID NOT OPEN2. LEAKED <br />O CLEANED <br />PSIDIFF. PRESS.-PSIDIFF. PRESS.. <br />PSIDPSIDAIR INLET OPENED AT PSIDRP <br />PSIDCHECKVALVE REDUCED PRESSURECLOSED TIGHTCLOSED TIGHT <br />■Z-' <br /> <br />DATE.CERTIFIED TESTER NO,INITIAL TEST BY <br />DATE.CERTIFIED TESTER NO,FINAL TEST BY. <br />COMMENTS: <br />THE ABOVE REPORT <br />IS CERTIFIED TO BE TRUE <br />(jam/ne/'cia/'~ <br />t’7 <br />(209) 334-9693 DATE_SIGNATURE. <br />Rick Wahl, Owner <br />License #632919 <br />MFR. <br />CHECK VALVE <br />HELD AT <br />LEAKED <br />INI­ <br />TIAL <br />TEST <br />FINAL <br />TEST <br />R <br />E <br />P <br />A <br />I <br />R <br />S <br />• Backflow Certification & Inslalfation <br />• Sewer & Drain Replaced & Repaired <br />• Water Heaters • Bathtubs <br />• Toilet & Faucet Repair <br />• Disposal Installation & Repair <br />CLEANED <br />REPLACED: <br />DISC <br />SPRING <br />GUIDE <br />PIN RETAINER <br />HINGE PIN <br />SEAT <br />DIAPHRAGM <br />OTHER, DESCRIBE <br />CHECK <br />VALVE <br />DIFF. PRESS. <br />CHECK <br />VALVE <br />DIFF. PRESS. <br />CLEANED <br />REPLACED: <br />DISC <br />SPRING <br />GUIDE <br />PIN RETAINER <br />HINGE PIN <br />SEAT <br />DIAPHRAGM <br />OTHER, DESCRIBE <br />O <br />DIFFERENTIAL <br />PRESSURE RELIEF <br />VALVE <br />CLEANED <br />REPLACED: <br />AIR INLET <br />DISC <br />CHECK DISC <br />AIR INLET <br />SPRING <br />CHECK SPRING <br />OTHER, DESCRIBE <br />PRESSURE VACUUM <br />BREAKER <br />a <br />o <br />CLEAN SENSING LINE(S) <br />REPLACED: <br />DISC: <br />UPPER <br />LOWER <br />SPRING <br />DIAPHRAGM: <br />LARGE: <br />UPPER <br />LOWER <br />SMALL <br />SEAT: <br />UPPER <br />LOWER <br />SPACER: <br />LOWER <br />OTHER, DESCRIBE <br />PSID <br />CUSTOMER: <br />■ <br />PSID <br />• //'' 's'I'7' <br />s .<. ./. <br />.. / z .7 . c- <br />DEVICE INFORMATION <br />/ X . MFR. ■•7. '//X/ / T <br /> MODEL NO. <br />AIR INLET /f <br />OPENED AT - <br />DID NOT OPEN <br />1. CLOSED TIGHT <br />RP PSID <br />2. LEAKED