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LOCATION OF DEVICE. <br />OUSTS <br />TYPE:SIZE <br />DOUBLE CHECK <br />REDUCED PRESSURE <br />PRES. VACUUM BREAKER <br />2008NOV 4REPORT OF TEST RESULTS <br />Reduced Pressure Principle Assembly <br />Double Check Valve Assembly <br />#2#1 <br />PSIPSI <br />PSIDOPENED AT 1. CLOSED TIGHT <br />DID NOT OPEN2. LEAKED <br />CHECK VALVECLEANED <br />HELD AT CLEAN SENSING LINE(S) <br />LEAKED <br />PSIDIPP. PRESS..PSIDIPP. PRESS.. <br />PSIDAIR INLET PSIDOPENED AT PSIDRP <br />PSIDCHECK VALVE REDUCED PRESSURECLOSED TIGHT <br />CERTIFIED TESTER NO. INITIAL TEST BY <br />CERTIFIED TESTER NO. FINAL TEST BY. <br />COMMENTS: <br />THE ABOVE REPORT <br />IS CERTIFIED TO BE TRUE <br />Gom/ne/T/a/ - ZZesu/e/ff/a/ <br />(209) 334-9693 <br />Duncan Press • Lodi <br />BAC?< <br />Rick Wahl, Owner <br />License #632919 <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 & Installation <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 />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 />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 />AIR INLET <br />OPENED AT <br />DID NOT OPEN <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES <br />PRESSURE VACUUM <br />BREAKER <br />PSID <br />PSID <br />DATE <br />DATE <br /> METER NO. /fr <br />DEVI <br />SIGNATURE^ <br />3W PREVENTION DEVICE T F REPORT , <br />,ER: <br />PHONE NO. <br />CITY V <br />INFORMATION <br />Z '' MFR.. <br />MODEL NO. SERIAL NO. <br />^ECEWED <br />SERVICE ADDRESS <br />1. CLOSED TIGHT <br />RP PSID <br />2. LEAKED <br />DATE //-2 Z/f