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ASSEMBLY LOCATION: <br />WATER PURVEYOR:INSIDE BUILDING:CA 95210 <br />REPORT OF TEST RESULTS <br />KFHAL <br />HELD AT (PSID)HELD AT (PSID) <br />□TEST LEAKED LEAKED LEAKED <br />1. CLEANED 1. CLEANED o*1. CLEANED 1. CLEANED 1. CLEANED□R REPLACED:REPLACED:REPLACED:REPLACED: <br />E 2. DISC □2. DISC 3. DISC (S)ZDISC 2. DISC <br />P 3. SPRING 3. SPRING 4. SPRING 3. DIAPHRAGM 3. SPRING <br />A 4. GUIDE 4. GUIDE 4. FLOAT 4. GUIDE <br />I S. SEAT 5. SEAT 6. SEAT 5. SPRING 5. SEAT <br />R 6. MODULE 6. MODULE 7. O-RJNGS (S)B. OTHER 6. MODULEs□7. OTHER 7. OTHER 8. MODULE 7. OTHER <br />9. OTHER <br />CLOSED TIGHT oCLOSED TIGHT | [FINAL CLOSED TIGHT | | <br />TEST <br />(RP) PSID (RP) PSID OPENED AT PSID OPENED AT PSID PSID <br />THE ABOVE REPORT IS CERTIFIED TO BE TRUE.□PASSED FAILED <br />TIME OF INITIAL TEST TIME OF FINAL TEST <br />START START END <br />FINAL TEST BY <br />CERTIFIED TESTER NUMBER <br />NUMBER DATE <br />o <br />D □ <br />O <br />□□ <br />NUMBER <br />SYSTEM PRESSURE : <br />2. EXERCISED <br />REPLACED: <br />PRESSURE REUEF <br />VALVE <br />~1 5. D1APHRAGM(S)| J <br />SIZE <br />END <br />•T BY rd- <br />ADDRESS: 2300 E. Eight Mile Rd <br />«"JTATtzip: Stockton, CA 95210 <br />CHECK <br />VALVE 41 <br />CLOSED TIGHT | | <br />PRESSURE TYPE <br />VACUUM BREAKERS <br />AIR <br />INLET <br />SERVICE ADDRESS: <br />________2300 E. Eight Mile Rd. <br />CITY, STATE, ZIP: <br />Stockton, <br />DOUBLE CHECK VALVES |________ <br />______REDUCED PRESSURE ASSEMBLY <br />CHECK <br />VALVE 8 2 <br />CLOSED TIGHT I <br />OPENED AT (PSID) <br />OPENED UNDER 1.0 PSID <br />OR DID NOT OPEN f <br />OPENED AT (PSID) <br />OPENED UNDER 20 PSID <br />OR DIO NOT OPEN I <br />. ______ASSEMBLY INFORMATION___________ <br />MODEL SERIAL # <br />INITIAL TEST B' <br />CERTIFIED TESTER NUMBER <br />NUMBER DATE <br />CHECK <br />VALVE <br />CLOSED TIGHT <br />HELD AT (PSID) <br />QUALITY SERVICE 209-838-7842 <br />_______ BACKFLOW PREVENTION ASSEMBLY TEST REPORT <br />WATER CUSTOMER MAILING ADDRESS <br />NAME; SBC Pacfic Bell / Eight Mite