20240913SWS to Staff 91 Supplemental Response - Test report 3.pdf

RECEIVED
Friday, September 13, 2024
IDAHO PUBLIC
UTILITIES COMMISSION
Water ( r File
Purveyor: V M n ��� (,� (,) � u I j No:
Service Address of assembly_
Location of assenrbh-on premise C`o u)c
supper to:
Owner of assembly 1 K q 1 f h I Y Li-Q L U hi la rt
Owner address: 2Cih' n n (.b a vd _ZIP k1 Ll
tfamifac turer: (�, (.�,.�� Alodel No: 7 Size _ Serial S > Z r
Sttde: RP O DC DCDA O RPDA O PVB O SVB O Orientation
New System Pressure
Install Reduced Pressure Principle Assemble at this location
Y I Zv PSI
Double Check Valve Assembly
--FCheck Valve# lT TCheck I idve#2 Relief!'dive PVB/SI'B
INITIAL Held atPSID Held at Z, Z PSID Air inlet
Opened at PSID opened at
TEST Closed tight Closed tight
Did not open O Opened Fully O
Leaked O Leaked O
Did not open O
Check valve
Cleaned O Cleaned O Cleaned O held at
REPAIRS Replaced O Replaced O Replaced O Leaked O
(Termed O
Replaced O
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked O Leaked O Did not o en O Check Valve
Comments:
Initial test bi•: C h n S 1 V a i Date:
Cerriflcation/Lh-ensc# R/1-1 2 S 3 IL pass 117 Fail O
Repaired/Cleaned by Date:
Final Test hy: Date:
Certification/Lic•ense# Pass O Fail O
Wliter servic•e restored? Y N::]
BAT Form wimple LW

2911 PO;,(ec
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME C'r Lq M �e t- ,I)
SERVICE ADDRESS ) it j re r �-� 13 a �U� 1-�^/�i 1
LOCATION OF ASSEMBLY
SUPPLY ^r;t _� 4-, C `
TYPE OF ASSEMBLY NEW INSTALL PSI L)
MANUFACTURER 1 1 u,'n C_ MODEL V SERIAL LI,Z SIZE /
PVB/SVB
CHECK VALVE#1 CHECK VALV PSID OPENED FULLY
#2 RELIEF VALVE AIR INLET OPENED AT PSID
n
HELD AT , '�PSID HELD AT <
INITIAL TEST CLOSED TIGHT d CLOSED TIGHT i OPENED AT PSID DID NOT OPEN
LEAKED r LEAKED n DID NOT OPEN Li DID
VALVE HELD AT
LEAKED
CLEAND CLEAND
REPLACED ❑ REPLACED CLEAND CLEAND n
REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED ❑ REPLACED
u
()VENED AT PSID AIR INLET OPENED
AT PSID
CLOSED TIGHT ❑ CLOSED TIGHT u DID NOT OPEN c CHECK VALVE HELD AT
LEAKED n LEAKED n —
PASS FAIL
GAUGE q 1 �. ij MAKE AND MODEL (i , -, ; , CALIBRATION DATE ?7671
l
TESTER LICENSE DATE
REPAIRED B'• r DATE
FINAL TEST BY LICENSE - L y DATE 2 It
WATER PURVEYOR 5 } �11 {/ ✓I �,
Nash & Soii RPM
RFAI TnR .1 ANDSICAVATION
1 �
v "ia
208.500.9747
Call or Text for an Estimate

= New
FxQ Existing
BACKFLOW ASSEMBLY TEST REPORT 0 Removed
Replacement
roperty David Ellis
Jwner
Mailing 18 San Souci Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 18 San Souci Dr Blanchard, ID 83804
Address
MR P R A =I)1.V A ® R P I)A O:)i D A a P'1 B A Q 1 v B A O A v[I Q AIR GAP
SIZE 1" MAKE Wilkins MODEL 375
Water Purveyor Stoneridge Prop.Water District Serial a B324501
Assembly Location left Side Of house
"f Di..L:•PRESSURE ASSEMBLY DOUBLE t,A `A INITIAL TEST
■T CHECK 9.0 �.R INLET •[�-K PASSED
INITIAL PRESSDRCw CHECK >'
13
TEST RELIEF VALVE 2.8 TIGHT ® PENEo PRESS FAILED
RESULTS 13
OPENED AT MIN?PSID (9I LEAKED (3 PS.-D AT DROP D//A��T��E
SUFFER 6 2 CHECK i2 PS(ll P501 Q&21-/23
A-B
BYPASS MIN 3 PSI GH
TIT
CHECK RELIEF VALVE ® Dlo N. SYSTEM PSI
.. ® FAIL Q LEAKED PSID RPFN ❑ ❑ 50
COMMENT'-
OMMENT' `)l1
REPAIRS
AND/OR
PARTS
•+T DU,.t SKr r+r ASSFMBL WA A AFTER
TEST qI CHECK REPAIRS
AFTER RESS DROP (AI PSID OPENED .LI
—`PAIRS PENS
Q AT DROP DATE
�PF.NF.D (8)
N PPSID CHECK i2 PSDI
MI PSOI
.•UFFER TIGHT PSID
A'B - a PASSED
MINA
IN k. LTINGANU SUBMITTING THIS TEST REPORt THE TESTER CERTIFIES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND STATE REGULATIONS
GAUGE CALIBRATION DATE 02-28-2023 DETECTOR METER READING
I�
T E R SiGNA- _
J mes Williams 12087777688 State Testef-
Darnall Sprinklers Certification :: Bat-16583
3172 W Setice Way Post Falls, ID 83854 Gauge# 12091184
REPORT RECEIVED BY ® SERVICE RESTORED
FOUND OFF.LEFT OFF

BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME Cotc-.^ I I It
SERVICE ADDRESS
LOCATION OF ASSEMBLY
SUPPLY
TYPE OF ASSEMBLY" NEW INSTALL PSI
MANUFACTURER .1 MODEL �, SERIAL SIZE
PVB/SVB
CHECK VALVE#1 CHECK ALVE#2 AIR INLET OPENED AT PSID
�n F LVE
HELD AT 3 ( PSID HELD AT ( PSID RELIE OPENED FULLY r:
INITIAL TEST OPENED AT PSID
CLOSED 11GHT CLOSED TIGHT DID NOT OPEN
LEAKED r. LEAKED DID NOT OPEN CHECK VALVE HELD AT
LEAKED
CLEAND r, CLEAND r,
REPLACED � REPLACED t; CLEAND r CLEAND a
REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED r., REPLACED t:
CLOSED TIGHT � CLOSED TIGHT u OPENED AT_PSID AIR INLET OPENED AT _PSID
I FAKED r LEAKED DID NOT OPEN CHECK VALVE HELD AT
PASS FAIL
NOTES
GAUGE p MAKE AND MODEL %1 �/� �•� �' CALIBRATION DATE ti C
TESTER LICENSE 4 (a 1 DATE
REPAIRED BY DATE
FINAL.TEST BY LICENSE DATE
WATER PURVEYOR
Mash & Son RPM
RFALTOR'•LANDSCAPING •FXCAVATION
J L 208.500.9747
Call or Text for an Estimate

Customer/Business Name: Stephan Rezac Date: 5/11/2023
28 Sans Soucii Dr
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: NEXT TO METER
Type of Hazard Controlled:
Assembly info-Make: WILKINS/950 XLT Serial# 511
RPBA RPDA Q.V DCDA PVB SVB Size(In): Line Pressure(PSI):
Installation:Horizontal: 61 N Vertical:VU VD Other-
New: Y /N1 Replaces Serial N
Chock Valve#1 _ _ Cbeek Vdve#2 Relief valve PVB/SVB Shut Off Valves
#I *2
Initial � Held at PSID � C1 Held at� ID PS ❑ Opened at ❑ Opened at
Test �-Closed Tightxlosed Tight PSID PSID Closed Tight
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ UPLA,CM- ❑ WLACM— ❑ RBPLAM.- ❑ REPLACED,
❑ Disc ❑ Disc ❑ Disc Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
G ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Rings)
g ❑ Module ❑ Module ❑ Module ❑ Guide
4C i ❑ ❑ ❑ _ ❑
NOTES:
Filtttl Qo Tight Closed Tight ❑ Opened At Air Inlet PSID Shut Of!Valves >Kl #2
Test PSID Z.G PSID PSID CK Valve PSID Closed Tight
NOTE: Purveyor must be notified within 24 bra or any backflow prevention assembly left in a failed(non-Passim;)condition.
Testers Name(please print): HAYDEN TANNER ID BAT License# :23903
Company Name: SPRINKLERS NORTHWEST Expiration Date: 05/01/24
Company Phone: [phone] Email:
Teat Fquipment Make& Model: MIDWfST 845 Serial lt:03141084
Calibrated By: B.A.T.SUPPLY Calibration Date: 09/24/22
1 certify the bly wan toetod in acordsoee with U.S C.tat protocol and was in working condition.
Teat Results: Passed Failed ❑ Assembly as Left: water Service Rester ft'1B— BAT TeR Auaehea--
slunre of Tav+
Copy of Report tn: CustomerlOwner ❑ w„cr Purveyor C3 Lk—od Tester ❑
Water Purveyor: STONERIDGE

t,sinalt -lit.%i:lCS%Na-P... P e 2 a C lcie: y— Z 9 -Z 4
;�-!K Sa►,S S-0-)c Nt D r.
A:.emGty Service Address:
81a KckAJ J-d 839'o q
I ocation of Assembly: lk
Type of Kazald Controlled:.
Assembly info Make: Y L J Serial# Z 76o.5�1
RPBA RPDAOp DCDA PVH S%'B Size(inn))): Line Pressure(PSI): l�—
installation: Horizontal: Y N Vertical: VU VD Other:
New: Y Replaces Serial t1:
cAee(:/y�stve fit `cu:ue yeive roc' Relief Veive Pt'Q/SV8Shur Off Valves
[maul ❑ Held at<—, ID .eld a�4(_
PSID ❑ Opened at ❑ Opeacd atTetiClosed Tight Closed PSID PSID Closed Tight
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑
11
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ Q
❑ BEP4L►CED: ❑ REPLACED 0 REM ACIM: ❑ REPIACW:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑
❑ Spring ❑ Spring Ej Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Sat ❑ Seat ❑ Seat ❑ Check Spring
❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O•Ring(s)
❑ Module 0 Module ❑ Module ] Guide
_�- - ❑-- 0 ❑---
1 NOTES:
B(a 11 los�edf Tight - Closed Tight ❑ Opened At
4L Air Inlet PSID Shut Oft Valves Ml r 021 i
a.Teti �t:s •mot SlD . - PSID PSID CK Valve PSID Closed Tight hJ-/
NOTE:Purveyor roust be notiftec within 24 hrs of any backliow prevention asstmbly left In a ralled(Rill-passlrtQ)tanditlon.
Tester's Name(please print): RICHARD STAFFORD ID BAT License#: 18145
Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/25/2024
Company Phone: [phone] Email:
Test Equipment Make& Model: MIDWEST 945 Serial H:02191467
Calibrated By: B.A-T & SUPPLY Calibration Date:09/21/23 ^
1 etniry the msemCl w tested in aeordann with t:S C rcat protocol and was in%otkloj condilwn
Teti Results: Passed � F 'led ❑ /.uemul�es CAR: Water ScndceRest, AT TogAnschdi-T"'
Syhrttar et Te.hrr Date
Copt'or Report go: custorne0ownor ❑ Water Purveyor ❑ Lkenued Testa ❑
Water Purveyor: a

Water File
Pumeror: �Mn e Y ► d fl b V I i I 1-� (J No:
Sen,ice Address of assembl►'
Location of assembly on premise
sumo,to: '1 n K I L►'�
Owner of assemblr:
Owner address: 2 d r . City an ( ad ZIP �U
Manufacture r:�LT I�,� � Model No: 7-,)/L7 Size � Serial Z/ 7
Stele: RP 0 DC 42t DCDA O RPDA O PVB D SVB O Orientation
New System Pressure
., Reduced Pressure Principle Assemble
InstallaLN
' at this location
y �` PSI
Double Check Valve Assemble
Check 1'alve# 1 L21hieck I aloe#2FT Relief VLJ alve PIT/SIB
__f
INITIAL Held at 2,Z PSID Held at .v PSID Air inlet
TEST Opened at PSID opened at
Closed tight �7 Closed tight
Did not open O Opened Fully O
Leaked O Leaked 0
Did not open O
Check valve
Cleaned O Cleaned O Cleaned 0 held at
REPAIRS Replaced O Replaced a Replaced O Leaked O
Cleaned 0
Replaced O
FINAL Closed light Closed tight Opened at Air inlet
TEST Leaked a Leaked a Did not open O Check I'alve
Comments:
Initial lest br: c h r 1 s K, Q l ► ) Date: J 10 Z 3
Certircation/License# b AT ZS-�qL'1) Pass I Fail O
RepairedlCleaned hr Date:
Fined Test br: Date:
Certiftcation/License# Pass 0 Fail O
Water service restored? N
BAT I wimple 1%k

aNew
x7 Exlsting
BACKFLOW ASSEMBLY TEST REPORT 0 Removed
Replacement
Property Rachael Miller
Owner
Mailing 22 Stewart Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 22 Stewart Dr Blanchard, ID 83804
Address
O R P B A. ® D C V A O R P D.A O D C D.A [:] P'V B A O S V B A.=A V B. [:3 AIR GAP
SIZE 1 " MAKE- Wilkins MODEL 950XL
Water Purveyor Stoneridge Prop. Water District Serial # 3421572
Assembly Location: meter
REDUCED PRESSURE ASSEMB-' 30UB-E CHECK P.V B A S`/B A INITIAL TEST
di CHECK AIR INLET CHECK
INITIAL PRESS DROP (A CHECK #1 TIGHT PASSED
TEST RELIEF VALVE ® 2.2 OPENED PRESS FAILED �
RESULTS OPENED AT MI 2PSID (B) -`AKED Q PSID AT DROP D(A�TTE/��
BUFFER PSDI PSDI Gal
A- B CHECK 02
BYPASS MIN 9 PSI
CHECK RELIEF VALVE rIGHT ® 2.5 DID NOT FAILED SYSTEM PSI
OPEN
PASS ❑ FAI_
_FAKED PSID 13 ,
;IL
65
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D.0 V A P V,S A ! S V B A
AFTER
TEST
CHECK CHECK #t REPAIRS
AFTER PRESS DROP (A) TIGHT P i DPENED PRESS
REPAIRS RELIEF 13 AT DROP DATE
OPENED (B)
MIN 2 PSID CHECK #2 PSDI PSDI
BUFFER TIGHT PSIS.
A-B [3 PASSED
MIN 3 PSI
IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERT,F ES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND S-ATE REGULATIONS
GAUGE CALIBRATI N DATF 02-05-2024 DETECTOR METER READING
YJ
TE TE I5NA-U
Tay or Fulwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
;REPORT RECEIVED BY
❑ SERVICE RESTORED
❑ FOUND OFF, LEFT OFF

New
Existing
BACKFLOW ASSEMBLY TEST REPORT 0 Removed
Replacement
Property Linda Levesque
Owner
Mailing 38 Stewart Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 38 Stewart Dr Blanchard, ID 83804
Address
= RPIIA aDCVA ® R P D A = D C D A a PV BA = S V BA = AVR AIR "AP
SIZE 3/4" MAKE Wilkins MODEL: 375
Water Purveyor Stoneridge Prop. Water District Serial # B408998
Assembly Location right side of house
•.EDUCED PRESS-mr A :,t lb.. UBLE CHECK V 8 A S V B A INITIAL TEST
41 CHECK
INITIAL PRESS DROP 7•8 (A) CHECK 01 AIR INLET CHECK PASSED 13
TEST RELIEF VALVE �-�
IGHT OPENED PRESS FAILED 13
OPENED AT (B) gKED PSID AT DROP
RESULTS MIN PSID 0 DATTE�S Q
BUFFER 4 5 PSDI PSDI QJ5� L�23
A•B CHECK a2
BYPASS MIN 3 PSI
RELIEF VALVE TIGHT
CHECK ® DID NOT FAILED SYSTEM PSI
OPEN
PASS ® FAIL [3 LEAKED Ef PSID [3 O 42
COMMENTS
REPAIRS
AND;OR
PARTS
REDUCED PRESSURE ASSEMBLY D C V A P V 8
TEST AFTER
tt1 CHECK CHECK 01 REPAIRS
AFTER PRESS DROP IA) TIGHT PSID OPENEDT7Ai
REPAIRS RELIEF 13 ATDATE
OPENED (B)
MIN 2 PSID CHECK o2 PSDI
BUFFER TIGHT PSID
MIN 3 PSI
A- B = 13 PASSED
IN COMPLETING AND SUBMITTING THIS TEST REPORT.THE TESTER CERTIFIES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND STATE REGULATIONS
G/ GE CALIBRATIO DATE 02-28-2023 DETECTOR METER READING
_)r
Dane Yalian 12087777688 State Testers
Darnall Sprinklers Certification n BAT-25372
3172 W Setice Way Post Falls, ID 83854 Gauge # 01191100
REPORT RECEIVED BY ® SERVICE RESTORED
❑ FOUND OFF, LEFT OFF

�-
3S ` ff-�'d`^�
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME Je LA C..
SERVICE ADDRESS Id,47-
- / �5,
LOCATION OF ASSEMBLY �j, 71 L,4
SUPPLY
-77
TYPE OF ASSEMBLY NEW INSTALL PSI S_5
MANUFACTURER �\� I 1 MODEL SERIAL SIZE /
PVB/SVB
CHECK VA 1 CHECK VALVE t;2 AIR INLET OPENED AT PSID
RELIEF VALVE
HELD AT PSID HELD AT 7•Z PSID � OPENED FULLY
INITIAL TEST OPENED AT ' PSID
CLOSED TIGHT 0 CLOSED TIGHT a DID NOT OPEN
LEAKED n LEAKED ❑ OID NOT OPEN u CHECK VALVE HELD AT
LEAKED L:
CLEAND n CLEAND o CLEAND ❑ CLEAND
REPLACED REPLACED a REPLACED a REPLACED
REPAIR/FINAL HELD AT PSID HELD AT PSID
CLOSED TIGHT � CLOSED TIGHT OPENED AT PSID AIR INLET OPENED AT PSID
LEAKED r LEAKED DID NOT OPEN CHECK VALVE HELD AT
PASS FAIL
NOTES
GAUGE p I j I i C I MAKE AND MODEL / / w l� �, CALIBRATION DATE /�/Z 1
TESTER LICENSE DATE
REPAIRED BY DA I f
FINAL TEST BY J LICENSE I y�}T 1 DATE 1
WATER PURVEYOR
Nash Son RPM
Rr.AI TOR- I ANf)CCAPINC; • FXC AVATICIN
208.500.9747
Call or Text for an Estimate

�� W.Riverstry Company, ite601 W.Riverside Ave.,Suite 510
Spokane,WA.99202
C!!TBuilding (509)475.15R?
Customer/Business Name: Macklin Residence Date: 8/1/24
Assembly Service Address: 77 Stewart Dr. Blanchard, Idaho 83804
Location of Assembly: In bushes on the west side of the driveway.
Type of Hazard Controlled: Irrigation
Assembly info-Make: Flomatic Model#: DCV Serial#:A6221
(circiet RPBA❑RPDA❑DC%'A 0 DCDA❑PVB❑SVB❑ Size(in): I" Line Pressure(Psi): 53
Installation: horizontal: 01' ON Vertical: ❑ VU ❑VD Other: NA
l l New: ❑T ON Replaces Serial NA
Check Vshe#1 Check Valve#2 Relief Valve PNIWSVB Shut OR Valves
al a2
Initial ® Held at 2•8 PSID 0 Held at 2•4 PSID [] Opened at ❑ Air Inlet opened at
Fesl 0 Closed Tight ® Closed Tight NA PSID NA PSID Closed Tight ® m
E] Leaked ❑ Lcakcd ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Lcakcd
CLEAVED CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED
[] Disc Disc ❑ Disc Poppet/Float REPLACED [] []
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
[] Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Scat ❑ Seal ❑ Scat ❑ Check Spring
[— ❑ hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ 0-Ring(s)
❑ Module ❑ Module ❑ Module ❑ Ciuide
❑ D ❑ ❑
C NOTEs:
None.
Final Closed Tight [] Closed Tight [] Opened At Air Inlet PSID Shut Off Valves 01 02
fat PSID PSID PSID CK Valve PSID Closed Tight ❑ ❑
NUTS:Purveyor must be notified within 24 hrs of any backflo% prevention asscmbh left in a failed(non-passing)condition.
Tester's Name(please print): Ery Nave I BAT License#: 15449/132856
Company Name: MCKinstry Company Expiration Date: 9/30/24
Company Phone: [phone] Fax#: NA
Test Equipment Make&Model: Midwest 845 Serial#: 10220061
Calibraied By: MGCunes Caliblatiun Datc. t 0/.30/24
1 cenify the assemhly was tested in acordance with U.S.C.lest protocol and was in working condition
Test Results: Passed 0 Failed ❑ Assembly as Left: Service Restored ® BAT Tag.Attached
8/1/24
Signature of Fester Date
Copy of Report to: C'ustomereOwner ® Water Purveyor ® Licensed Tester 0
Water Purveyor: Stoneridge Utilities
Notch Idaho Regional Water Purveyors LUck0ow Assembly rest Report NIRWP 0-AM.GS

trMcKinstry Company,LLC
y 601 W.Riverside Ave.,Suite 510
Spokane,WA.99202
ife Of Your Building [phone]
Customer,Business Name: Macklin Residence Date: 5/31/23
Assembly Service Address: 77 Stewart Dr. Blanchard, Idaho 83804
Location of Assembly: In bushes on the west side of the driveway.
Type of Hazard Controlled: Irrigation
Assembly info-Make: Flomatic Model#: DCV Serial -: A6221
icirclet RPBA❑RPDA O DCVA O DCDA❑P%'B❑s%'B❑
Size(In): 1 Line Pressure(PSI): 68
Installation:Horizontal: 0 Y a N Vertical: ❑ VU ❑VD Other: NA
(circle) New: t7 Y 0 N Replaces Serial It: NA
Check Vah a 01 Check%'al%e#2 Reiter vai a PVB/S%'B Shut Off Valves
#1 #2
Initial ® Held at 2.5 Pslu ® Held at 1.6 PSID ❑ Opened at Air inlet opened at
Test m Closed Tight m Closed Tight NA PSID NA PSID Clowd I-iEtn
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leokcd ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED (LEANED ❑ ❑
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACEDi
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
~ ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ringgs)
z ❑ Module ❑ Module ❑ Module ❑ Guide
❑ ❑ ❑ ❑
a NOTES:
None.
Final Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet PSID Shut Off Valves #1
Test PSID PSID PSID C K Valve PSID Closed Tight
NOTE:Purveyor must be notified within 24 hrs of any backllow prevention assembly left in a failed(non-passing)condition.
Testers Name(please print): Efv Nave ID BAT Liccnse#: 15449/62856
Company Name: MCKinstry Company Expiration Date: 9/30/23
Company Phone: [phone] Fax#: NA
Test Equipment Make&Model: Midwest 845 Serial#: 10220061
Calibrated By: MOCunes Calibration Date: 10/4/22
1 certify the assembly was tested in acordanee with U.S.C.test protocol and was in working condition
Test Results: Passed 0 Failed ❑ Assembly as Left: Service Restored 0 BAT Tait Attached
5131/23
Sigruturc of Tesler Date
Copy of Report to: Customer/Owner ® Water Purveyor ® Licensed Tesler
Water Purveyor: Stoneridge Utilities
North Idaho Regional Watcr Purveyors Hacknow•Assembly Test Report NIRWP 0.AM.GS

Customer/Business Name: Don Carrico Datc 05/10/2'-
Assembly Service Address: 113 Stewart Dr
Location of Assembly: right side of driveway
Type of Hazard Controlled: sprinkler system
Assembly info-Make: Wilkins Model#: 720A Serial#: T546165
(circlet RPBA ORPDA EI DCVA❑DCDA❑PVB❑SVB❑ Size(In): 1 11 Line Pressure(PSI): 70
Installation:Iloruontal: OY ❑N Vertical: VU VD Other:
(circk) New: ❑Y l7 N Replaces Serial#:
Check Valve Of Check Valve#2 Relief Valve PVB/SVB Shot OR Valves
41 -2
Initial ❑ Held at PSID ❑ Held al PSID ❑ Opened at Q Air Inlet opened al
'test ❑ Closed Tight ❑ Closed Tight PSID 3.0 PSID Closed Tight Q Q
❑ Liked ❑ LeAcd ❑ Opened Fully Q Opened Fully
❑ Did Not Open ❑ Did Not Opal Leaked ❑ ❑
Q Check held at
2-2 PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED Cl ❑
Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
w ❑ Scat ❑ Scat ❑ Seat ❑ Check Spring
❑ Hinge Pin ❑ hinge Pin ❑ O-Rings) ❑ O-Ring(s)
O ❑ module ❑ Module ❑ Module ❑ Guide
a
y ❑ ❑ ❑ ❑
NOTES:
Final ❑ Closed Tight ❑ Closed Tight ❑ (Wried At Air Inlet 3.0 PSID Shut Off Valves #1 li'
Test PSID PSID PSID CK Valve 2.2 PSID Closed'I lhhl ❑r 0
NOTE:Purveyor must be notified within 24 hrs of any backflow prevention assembly left in a failed(non-passing)condition.
Tester's Name(please print): Colton J Heilman ID BAT License#: 26409
Company Name: Elements Landscaping Expiration Date: 09/26/23
Company Phone: [phone] Fax#:
Test Equipment Make&Model: Midwest 845 Serial#: 02220624
CcdibtaRnl Dy. Backflow Assembly To-sting & SupplV Calibration Date: 03/12/23
L certify the assembly was tested in acordance with 1 I S.C.test protocol and was in working condition
Test Results: Passed ❑✓ Failed ❑ Assembiv as Left: Service Restored ❑ BAT Tat;Attached ❑✓
CAT---- 05/10/23
Signature of'r�tcr Darr
Copy of Report to: Customer/Owner O Water Purveyor a Licensed Tester ✓❑
Water Purveyor: City of Coeur d'Alene
North Idaho Regional Water Puny von Haekfloa Assembly rest Rc{xrrt NiRWP 19)-AM. 6S

Customer/Business Name: Don Carrico Date. 04/26/24
Assembly Service Address: 113 Stewart Dr
Location of Assembly: right side of driveway
Type of Hazard Controlled: sprinkler System
Assembly info-Make:Wilkins Model#:720A Serial#:T546165
teitcio RPBA❑RPDA EI DCN'A❑DCDA❑PVB❑S%-B❑ Size(In): 1 . Line Pressure(PSI): 60
Installation:horizontal. 0 Y O N Vertical: VU VD Other:
New: 01' ©N Replaces Serial#:
Check N'alsc it Check Valve 02 Reiier%'ahc PYR'S\'tl Shut Off Valves
zI A2
Initial ❑ Held at PSID ❑ Hcld at PSID ❑ Opened at Q Air Inlet opened at
est Closed Tight [3 Closed Tight PSID 5•0 PSID Closed Tight Q Q
❑ Leaked ❑ Leaked ❑ Opened Fully E] Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑
Q Check held at
2.0 PSID
Leaked
CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ REPLACED: ❑ REPLACED; ❑ REPLACED: ❑ REPLACED:
Disc ❑ Disc ❑ Disc ❑ Poppet I Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ .Air Inlet Spring
Guide ❑ Guide ❑ Guide ❑ Check Disc
r:
Seat ❑ Seat ❑ Seat ❑ Check Spring
❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Ring(s)
y. ❑ Module ❑ Module ❑ Module ❑ Guide
y ❑ ❑ ❑ ❑
NOTES:
Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet 5.0 PSID Shut Off Valves yl 42
lest PSID 11SID PSID CK VaRe 2.0 PSID Closed Tight ❑r ❑r
NOTE:Purveyor must be notified N ithin 24 hrs of any backflow prevention assembly left in a failed(non-passing)condition.
Tester's Name(please print): Patrick Taylor ID BAT License#: 26947
Company Name: Elements Landscaping Expiration Date: 01/13/26
Company Phone: [phone] Fax#:
Test Equipment Make&Model: Midwest 845 Serial#: 03240122
t alibralcd tiy: Backfluw Assembly Testing & Supply Culibrutivu Daw; 03/15/24
I ceritfy the asseirthly was tested in aconlance with U.S.C.test protocol and was in working condition
Test Results: Passcd ✓ Failed ❑ Assembly as Left: Service Restored ❑ BAT Tag Attached ✓❑
` 04/26/24
Signature of tester Date
Copy of Report to: CustomerlOwncr 0 Witter Purveyor ✓❑ Licensed Tester ❑✓
Water Purveyor: City of Coeur d'Alene
North Idaho Regional Water Pun eyom Hackflow•Assembly I est Report NIRW P 0-AM.US

BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME ';�.lC LQ- Ir 1 f I y-
SERVICE ADDRESS 1 L) S `` (J<1r /` >
LOCATION OF ASSEMBLY (� {)FLie L�1,1
SUPPLY �,/', L
TYPE OF ASSEMBLY �� NEW INSTALL PSI
MANUFACTURER S MODEL 7 .90 A SERIAL 3 S-2LI SIZE /
PVB/SVB
CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID
INITIAL TEST
HELD AT PSID HELD AT PSID OPENED AT PSID OPENED FULLY lim—
CLOSED TIGHT CLOSED TIGHT a DID NOT OPEN ❑ DID NOT OPEN u (,/
LEAKED cl LEAKED u CHECK VALVE HELD AT1
LEAKED❑
CLEAND n CLEAND
REPLACED c REPLACED CLEAND CLEAND I.
REPLACED REPLACED
REPAIR/FINAL HELD AT PSID HELD AT PSID c
CLOSED TIGHT a CLOSED TIGHT �: OPENED AT PSID AIR INLET OPENED AT PSID
r., n DID NOT OPEN a CHECK VALVE HELD AT
LEAKED LEAKED
PASS FAIL
NOTES
GAUGE# ( 7, l MAKE AND MODEL /�i �' L .��- S CALIBRATION DATE
TESTEf LICENSE DATE
REPAIRFD BY DATE
FINAL TEST BY LICENSE DATEjNC. ) tr Y r -2 [
WATER PURVEYOR �+L,,'i k L
Nasli 8� Son RPM
' -I ANnl,f7A fI (C
208.500,9747
Call or Text for an Estimate
U�

Water (� File
Purveyor:�I n e r l d Q — U�h l i,r1 t j No:
Service Address of assemble 12 �- rVt,) /, L epa cl
Location of assemh(y on premise r I l+r1
supply to: r i n K l a
Owner of assemhly:
Owner address: r d City t afiL ZIP q
Manufacturer, (JcJ a 1 �, -� 5 Model No: �Zp 4 Silt_LSeriol �1i ez
Style: RP O DC O DCDA O RPDA O P1,011d SVB O Orientation
New System Pressure
Install ? Reduced Pressure Principle Assemhl_v at this location
Y LN _Double Check Valve Assembly PSI
--FCheck ►'aloe# 1 TT77--hec7kVa71ve#2 Relief Valve PVB/SVB
INITL4L held at24�— PSID held at PSID Air inlet
Opener!at /'.SIU opened at 3.
TEST Closed tight O Closed tight O
Did not open O Opened Fully
Leaked O Leaked O
Did not open O
Check valve
Cleaned O Cleaned O Cleaned O held at
REPAIRS Replaced O Replaced O Replaced O Leaked O
Cleaned O
Replaced a
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked O Leaked O
Did not open O Check !'111ve
Comments:
Initial test by: Chris N Q 5 1' I Date: ,d -
Certification/License# 13 AT 2-0Iq 1b Pass! Fail O
Repaired/Cleaned by Date:
Final Test by: Date:
Certirication/License# Pass O Fail C
Water service restored? N
BAT F.--pk LW

F7 Now
QExisting
BACKFLOW ASSEMBLY TEST REPORT MRemoved
QReplaument
Property Curt Waffle
Owner
mmiing 131 Stewart Drive Balnchard, ID 83804
Address Phone [phone]
Assembly 131 Stewart Drive Balnchard, ID 83804
Address
aN P R A a V f Y A E3 R Pr,A O o CAA ® P V GA C31,Y R A Q A V R a AIR.Ak
SIZE 3.4" MAKE Watts MODEL 008M40T
water Purveyor stoner+dge Prop. Water Distnel Serial Ir 144690
Astvmb►y Location Left side of house
UtmX00ft -%t . I I . • ' •• , INITIAL TEST
tiE"DROP r. PASSED
IN I1 IAL --- w:
TEST i s.Ef VALVE ❑ FAILED 13
afNEO AT — - a f:
RESULTS ��ro `A0L1:V Q P*w DATE
3.6 GS,26-,-23
a - crEzr: � .
BYPASS PSI
ar.r r S 'ST (Yt Y' E
CHECK �+.Y:l,lC}' YAI�.� ''� 0 Dow-. r ,
Asz �, ��, o �A+ceo er a o �o
CUMM Erg��
REPAIRS
AND/OR
FARTS
E7 xmci J'R'X'ttl oft A21m
TEST s A ,Ei
Ira REPAIRS
AFTER Pttf,as taiiCAl• .� +.�t�IJ Pttt�s
REPAIRS R€L," 0 At ate° DATE
OFENEG I9 i
mod P31itJ CNtCx /. -
5111frffJ TNaw PS►D
sI PASSED 13
F"CC1MPttTiN4 AW&U8%Q Tie*TEST RVOCAT,t#*TVSTtsii CeRTVL4 t t►1AT
tn{s ASSt'LOLV""B[EN t E ry AND U&INTAIWO MACC0RDANCE MnTrt ALL APPILK-A LE MJLElf
AW ft.CAILAT ONO f.N I►* RATlR Sr4TlrM AW STATE VICU "T►W5
GAUGE CALIBRATION DAZE 02-28-2023 DETECTORMETER READING_
TLr q S •_.�►�J
mes Williams 12087777688 Rrde Taus,
Darnall Sprinklers cectalcmior- a Bat-16583
3172 W Setice Way Post Falls, ID 83854 age it 12091184
_. ® SERVILE REStORlED
Q FOUND OFF. LEFT OFF

�S l O ct-v4-
aNew
F7 Existing
BACKFLOW ASSEMBLY TEST REPORT Removed
Replacement
Property Curt Waffle
Owner
Mailing 131 Stewart Drive Balnchard, ID 83804
Address Phone [phone]
Assembly 131 Stewart Drive Balnchard, ID 83804
Address
RPBA- O DCVA O RPDA = DC D A ® P V B A O S V B.A.a A V B. O AIR GAP
SIZE 3/4" MAKE Watts MODEL 008M4QT
Water Purveyor Stoneridge Prop. Water District serial # 144690
Assembly Location: Left Side Of house
REDUCED PRESSURE ASSEMBLY ZIOUBLE CHECK P.V B A i SVEA INITIAL TEST
01 CHECK AIR -HECK
INITIAL PRESS DROP (AI CHECK #1 PASSED
TEST RELIEF VALVE TIGHT [3 OPENED PRESS FAILED
RESULTS OPENED AT MIN 2PSID (B) LEAKED [3 PSID AT DROP DATE
SUFFER 4.6 CHECK $12 PSDI J�ILE
��
BYPASS MIN 3 PSI
RELIEF VALVE TIGHT O NOT SYSTEM PSI
CHECK I'DIO
PEN C
SASS 0 FAIL Q LEAKED PSID Q75
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D C V A P V.B A SVBA
AFTER
TEST
qt CHECK CHECK *1 REPAIRS
AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS
REPAIRS RELIEF Q AT DR°P DATE
OPENED (8�
MIN 2 PSID CHECK n2 PSDI cSDI
BUFFER TIGHT PSID
A-B PASSED
MIN 3 PSI
IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE-ESTER CERTIFIES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND STATE REGULATIONS
GAUGE CALIBRATI N DATE 02-05-2024 DETECTOR METER READING
IL -ZlY
TE.TE NATU
Tay or FuIwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
REPORT RECEIVED ❑ SERVICE RESTORED
❑ FOUND OFF, LEFT OFF
u`

I I 1 Sf-eqww,
Customer/Business Name: Delia Beck Date: 5/9/2024
171 Stewart Dr
Assembly Service Address: Blanchard, ld 83804
Location of Assembly: in crawl by VB
Type of Hazard Controlled:
Assembly Info-Make: WILKINS MODEL: 950 XL,,T// Serial# 2978460
RPHA RPDA VA DCDA PVB SVB Size(In): .L— Line Pressure(PSI): O
Installation:Horizontal: N Vertical: VU VD Other:
New: Y �) Replaces Serial #:
r -- CheckVslve#i �— Check Valve Relief Valve PVB/SVB Shut ORValva
#1 N2
Initial Held at PSID Held atPSID ❑ Opened at Opened at
Test Closed Tight [� Closed Tighl PSID PSID Closed Tight
Leaked ❑ Leaked Opened Fully E] Opened Fully
❑ Did Not Open 0 Did Not Open Leaked D [�
Check held it
iPSID
Leaked
❑ CLEANED ❑ CLEANED 0 CLEANED ❑ CLEANED CLEANED [� ❑
❑ REPLACED: ❑ REPLACED: REPLACED- ❑ REPLACED:
❑ Disc Disc Disc ❑ Poppet/Float REPLACED [] ❑
❑ Spring ❑ Spring ❑ Spring Air Inlet Spring
❑ Guide ❑ Guide 0 Cmide 0 Check Disc
1] Seat C3 Seat ❑ Seat ❑ Check Spring
G ❑ Hinge Pin ❑ Hinge Pin El O-Ring(s) ❑ O•Ring(s)
Module ❑ Module El Module (] Guide
a ❑ O 11
-
o�C NOTES:
I
Final Closed Tight Closed Tight ❑ Opened At Air Inlet PSID Shut Off Valves #1 #2
Test r v_PSID 0 I PSID PSID CK Valve PSID Closed Tight (a
NOTE:Purveyor must be notified within 24 hn of any backilow prevention assembly left in a failed(non-passing)condition.
Tester's Name(please print):NICK NEVAREZ ID BAT License# : BAT-26182
Company Name: SPRINKLERS NORTHWEST Expiration Date:2/21/25
Company Phone: [phone] Email:
Test Equipment Make&Model: MAKO MK-5 Serial#:02AC22040142
Calibrated By: MAKO Calibration Datc 9/21/2023
i certify the ass
e
mbly wag tcstat in scvrdance with U.S.C.tar protocol and was in working condition
Test Results: Passed IEJ� Failed ❑ Assembly an Left: water Service Renoredm HAT Tag Anachedj2l
:2
Slgoature ar 7eNerl Date
Copy of Report to: Custorntdpwrrcr ❑ Wnrer Purveyor ❑ Liceused Tare,
Water Purveyor: ��4� -�

Customer/Business Name: Delia Beck Date: 5/11/2023
171 Stewart Drive
Assembly Service Address: Blanchard, ld 83804
Location of Assembly: in crawl by VB
Type of Hazard Controlled: ��(—,-'"
Assembly info-Make: WILKINS MODEL: 950 XLT Serial# 2978460
RPBA RPDA CLl IKDA PVB 5YB Size{In): Line Pressure(PS[):45�5—
Installation: Horizontal: N Vertical: VU VD Other:
New: Y Replaces Serial #:
Cbeek Valve#1 Check Valve#2 Re9dValve PVB/SVB Sbu__t_OQVdves
#I #2
initial (� Held at_ i�PSID FIeld at SID Opened at ❑ opened at -
Test ��Closed Tight Closed Tight PSID PSID Closed T.SM
❑ Leaked ❑ Leaked ❑ Opened Frilly Opened Fully
Did Not Open Did Not Open Leaked
❑ Check held at
PSID
�_ _ ❑ d
❑ CLEANED ❑ CLEANED CLEANED I ❑ CLEANED CLEANED ❑ ❑
❑ REPLACED: ❑ REPL,AaD: UPLACED: I ❑ RULACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Scat ❑ Check Spring
A ❑ hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ri*s)
❑ Module ❑ Module ❑ Module ❑ Guide
a ❑ - _ ❑ ❑ -- - �❑ _.
o� NOTES: -- — -— -- — —
Final eq-Oosed Tight t5-Qj edd Tight ❑ Oprnod At Air Inlet PSID Shut Off Valvtt:s 01 #2
Test PSID ( ZfStD PSID CK Valve PSID Closed Tight '191
NOTE:Purveyor must be notified within 24 bra of any backflow prevention assembly left in a failed(non-passine)condition.
Tester's Name(please print):HAYDEN TANNER ID BAT License#: 23903
Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24
Company Phone: [phone] Email:
Test Equipment Make&Model: MIDWEST 845 Serial#:03141084
Calibrated By: B.A.T.SUPPLY Calibration Date:09/24/22
1 certify the assembly wss tested in aeordance with U.S C.test protocol and was in working condition
Test Results: Passed ^5-. Failed ❑ Assembly as Left: Water Service Restore1Q, BAT Tea Attache
liaoatYR M Toter Date
Copy of Report on: cuctomerh 4or ❑ Water Purveyut ❑ Licensed Toter ❑
Water Purveyor: BLANCHARD

Customer/Busine-o.Name: Brandon Campea Date: 5/17/2024
205 Stewart Dr
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: By 2nd Tree right side
Type of Hazard Controlled irr
Assembly info-Make: WILKINS MODEL: 350 Serial# A596627
RPBA RPDA eMDA PVB SVB Size(In): ' Line Pressure(PSI):
Installation:Horizontal N Vertical:VU VD Other:
New: Y Replaces Scrial #:
i Cheek Vttive#1 Check Vaiw#2 { ReMerVatw PVB/S1B _Shut Off Valves
• I t� #1 #2
H Initial Held a.�PSID d atZ PSID ❑ Opened at ❑ Opened at
Test i�iClosed Tight ` Closed Tight PSID PSID Closed Tight
❑ Leaked ❑ Leaped ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED [] ❑
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED [� ❑
❑ Spring ❑ Spring ❑ spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(s)
A ❑ Module ❑ Module ❑ Module ❑ Guide
96 ❑ ❑ ❑ ❑
NOTES-: — - - — -- -
Final losed Tight TCltued Tight ❑ Opened At Air Wet PSID Shut OffValves #1 #2
Test NO PSID ��PSID PSID CK Valve PSID Closed Tight L
NOTE:Purveyor trust be notified within 24 brs of any backilow prevention assembly left in a failed(son-passing)condition.
Tester's Name(please print):RICHARD STAFFORD ID BAT License#!: 18145
Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/25/2024
Company Phone: [phone] Email:
Test Equipment Make&Model: MIDWEST 845 Serial#:02191467
Calilwaied By: B.A.T.&SUPPLY Calibration Date:09/21/23
t cesttty the asrembl u tested is eeordanee with U.S.C.test protocol and was to w�orkiag condition.
Test Results: Passod .1� Failed ❑ Assembly as i.eft: water Smlce ReaorodAT 7sK Otte:he
S.parure of Tmer Dam
Copy or Report to: Custonwfownde ❑ water Purveyor ❑ Lwcuscd Tester ❑
Water Purveyor: STONERIDGE

Customer/Business Name: Brandon Campea Date: 6/1/2023
205 Stewart Dr
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: V)Cj 5{twok. .k By 2nd Tree right side
Type of Hazard Controlled:
Assembly info-Make: WILKINS MODEL: 350 Serial# A596627
RPBA RPDA 1< A DCDA PVB SVB Size(In): Line Pressure(PSI):
Installation: Horizontal P N Vertical:VIJ VI) Other.
New: Y I Replaces Serial #:
Check Valve Nl Check Valve#i Reilef Valve PVB/SVB_ Sbut Off Valves
Initial Held&ZLPWD fTl Meld at��PSID ❑ Opened at ❑ Opened at 01 #2
Test sed Tight ��Clused Tight PSID PSID Cwftd Tim
❑ Leaked ❑ Leaked ❑ Opened Fully Opened Fully
❑ Did Not Open ❑ Did N•.il Open Leeched ❑ ❑
❑ Check held at
PSID
Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ RU.LA= ❑ UXLAGF.>Z: ❑ RFs LACED: ❑ gxal ACM;
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
C ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Rings)
❑ Module ❑ Module ❑ Module ❑ Guide
NOTES:
Final Closed Tight _ ZS
— — I ❑ Opened At Air Inlet — PSID Shut Off Vslves ill #2
Test �6 PSID fl PSID CK Valve PSID Closed Tight
NOTE:Purveyor mist be nodfled within 24 hrs of any backflow prevention assembly left in a failed(non-parsing)condition.
Tester's Name(please print):HAYDEN TANNER ID BAT License#:23903
Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24
Company Phone: [phone] Email:
Test Equipment Makc&Model: MIDWEST 845 Serial#-.03141084
Calibrated By: B.A.T. SUPPLY Calibration Date:09/24/22
I certify the s;stanbly was tested to aeordancc with U.S.C.test protocol said was in working condition.
Test Results: Passed Failed ❑ Aaa blv as Lent Walter Service Restored BAT Tag Attached
SiaaanreofTap� f
Cam of Report on: Customer/Owner ❑ watarPurveyor ❑ Ltosawd,Tater ❑
Water Purveyor: STONERIDGE

aNew
E3Existing
BACKFLOW ASSEMBLY TEST REPORT M Removed
QReplacement
Property Joe Gorgas
Ow ne r
Marling 232 Stewart Dr Blanchard. ID 83804
Address Roane 208-437-0743
Assembly 232 Stkev.art Dr Blanchard, ID 83804
Q0 PBA Q O V A a R P C A O C D A ® P V CA Q %v R A Q A V C 0 AIR GA61
SIZE: 1 MAKE Wilkins MODEL 720A
water Ru.v.ro. Stonendge Prop. Water District Serial R CAA22382
Assembly Location meter
Pit ti',PRILb54-00 "StWk - � A jDR
INITIAL TEST
fT (':fi{C.7t
I�NlSSCiIiC� nn[T PASSED
cNIT tAt � -- 'T EST RELiffIVALA'' ❑ „1' 0,,, FAILED QA RESt}L1S tAr a�ri2' w tAxer E] t•fi._ pgTE
05,26_-23
A d Gh!{:11 e2t3YPA$I$ NIP"CHECK RCUEF vA('✓t 13 MNYYT SYSTTEMPS,
❑ eArtEt+ �� o O
COMMENTS
REPAIRS
ANDfOR
PARTS
0uCeD;,#iz a I t Rf A55efi1.ri'r t!C V A o v t1 A %v 9 A
TEST AFTER
f! C"eCK cr�c>t fr REPAIRS
AFTER F*EJM0 OP 1Al Tin"T aa!o CWtNdL rNX55
REPAIRS OCLLcr 1 0 AT Cal" DATE
GENE0 1'nI _
Mki�7 aaf1L► CHECK !? ---plio— PSEX
3iJFFf7t T1r3M MG
A d -
Q� T Air PASSER Q
N CCXAftETHWi Aw s(uus T043 MST RIPPORT,t?!T"TE.t CLFfttP"THAT
CF1[AESE4R8l�'HA2i t9EEiV►C TED ANP YAINTAINEG!N AGGORUAgCf yyTTMALI Af'vuG.Ada.E�nfa
AAiT1 OF TtTWATFR SYSTT1101 ANn STATE M*C"_AT70N*
GAUGE CALIBRATION UAI E 02-28-2023 DETECTOR ME1 ER READING
1
James Williams 12087777688 State 'Testers
Darnall Sprinklers GCf;rsi (t , s gat-16583
3172 W Setice Way Post Falls. ID 83854 Gauge n 12091184
© SERVICE RESTORED
0 FOUND OFF LEFT OFF

tit
New
F77 !Existing
BACKFLOW ASSEMBLY TEST REPORT Removed
Replacement
Property Joe Gorgas
Owner
Mailing 232 Stewart Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 232 Stewart Dr Blanchard, ID 83804
Address
a R P B.A a D C V A O R P D.A O D C D A ® P V b A [::] S V B A a A V B [::]AIR GAP
SIZE 111 MAKE: Wilkins MODEL. 720A
Water Purveyor Stoneridge Prop. Water District Serial # CAA22382
Assembly Location: meter
REDUCED PRESSURE ASSEMBL'• 71=01-16LE CHECK P,V g A S.,JEK
INITIAL TEST
41 CHECK AIRINLE" C
INITIAL PRESSDROP (A� CHECK #1PASSED IM
TEST RELIEF VALVE TIGHT OPENEC PFAILED 13
OPENED AT (B) =AKED PSIC A' D
RESULTS MI 2 PSID 3DnATTE/�p �^
BUFFER PSDI QS/�124A,B CHECK #2BYPASS MIN 3 PSI TIGHT
CHECK RELIEF VALVE C3 DID NOT FASYSTEM PSI
PASS ❑ F.AI_ a -=AKEO PSID ❑ 78
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D.0 V A P V B A , S V B A
AFTER
TEST #1 CHECK CHECK #1 REPAIRS
AFTER PRESS DROP iA) TIGHT PSID ='ENED PRESS
RELIEF Q AT DROP DATE
REPAIRS OPENED (B)
MIN 2PSID CHECK #2 ;:?`DI PSDI
BUFFER TIGHT PSID.
A-B Cl PASSED 13
MIN 3 PSI
IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE'ESTER CERTrF,ES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND SATE REGULATIONS
GAUGE CALIBRATI N DATF 02-05-2024 DETECTOR METER READING _
TE TF _IoNATL
aorT Fulwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
REPORT RECEIVED BY ❑ SERVICE RESTORED
❑ FOUND OFF, LEFT OFF

3 -, r f-- -r
New
aExisting
BACKFLOW ASSEMBLY TEST REPORT 0 Removed
Replacement
Property Bill Postmus
Owner
Mailing 243 Stewart Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 243 Stewart Dr Blanchard, ID 83804
Address
R P B A ® D C V A [D R P D A [-] D C D A O P_V 6 A [::] S V B A a A V B =AIR GAP
SIZE 1 " MAKE Wilkins MODEL 350
Water Purveyor Stoneridge Prop. Water District Serial # A651259
Assembly Location: Left side of House
REDUCED PRESSURE ASSEMBLY DQUB_E CHECr� P.V B A SVBA INITIAL TEI-T
Ct CHECK AIR INLET CHECK
INITIAL PRESS DROP (A) CHECK 91 PASSED
TEST RELIEF VALVE TIGHT
® 1 .6 OPENED PRESS FAILED
RESULTS OPENED AT MIN 2 PS ID (B) LEAKED r PS'C AT DROP DATE
°SDI PSDI M/-EAFER / � /24B CHECK q2
BYPASS MIN 3 PSI
CHECK RELIEF VALVE TIGHT ® 1 8 DID NOT FAILED SYSTEM P'--)
OPEN
PASS � FAIL [3 LEAKED SiD P a a 77
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY DCVA P V.B A SVBA
AFTER
TEST C1 CHECK CHECK at REPA RS
AFTER PRESS DROP (A) TIGHT PSIj OPENED PRESS
REPAIRS RELIEF
10 AT DRi sP DATE
OPENED (B)
MIN 2 PSID CHECK 02 PSDI ZI S DI
BUFFER TIGHT pSIG
A-B " 13 PASSED
MIN 3 PSI
IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE'ESTER CERTIFIES THAT
THE.ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM,AND STATE REGULATIONS
GAUGE CALIBRATI N DATF 02-05-2024 DETECTOR M ETER READING
Tay Or Fulwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
REPJRT RECEIVED BY SERVICE RESTORED
❑ FOUND OFF, LEFT OFF
0k

New
Existing
BACKFLOW ASSEMBLY TEST REPORT = Removed
Replacement
roperty Bill Postmus
Owner
Mailing 243 Stewart Dr Blanchard, ID 83804
Address
Phone [phone]
Assembly 243 Stewart Dr Blanchard, ID 83804
Address
a 1,PBA ®I,�.VA [DRPIIA 11A [::] PV BA V B AOAVB aAIR GAP
SIZE 1" MAKE Wilkins MODEL 350
Water Purveyor Stonerldge Prop, Water District Serial a A651259
Assembly Location Left side of House
L, I.:,I-OtE: -f ASSEMB: PvI:A HA INITIAL TEST
�I CHECK AIR INLET CHECK INITIAL RESSDROP IAI +E':r PASSED
p
TEST '+CLIEf VALVE
IGHT E ® 1sZ OPENED PRE 55 FAILED 13
PENED At IBI LEAKETI c'SID AT DROP
RESULTS MIN2 PSID ❑ DADATE��QpQ II��
-LIFTER PSDI PSDI 05/1 �23
A-8 CHECK it
MIN!PSI
TII�HT
tiELIEF VALVE to DIE)DID NOT FAILED SYSTEM PSI
OPEN 13 13
PASS Q FAIL Q .F AKE Ct PSID
CUhih1EN'
REPAIRS,
AND/OR
PARTS
'+EDUCfD PRESSURE ASSEMBLY DIVA P 11SVPA AFTER
TEST ui CHECK CHECK ■1REPAIRS
AFTER RESS DROP (A) TIGHT CSID OPENPAIRn '�ULIEV Q AT DATE
,PFNF.D (a)MIN 2 PSID CHECK a2PS
r'I.IFFER TIGHT PSID
A.B • D PASSED
IN3SI-
.L 1,NG AND SUBMITTING THIS TEST REPORT.THE TESTER CERTIFIES THAT
I It.A.,SEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL ACPLWAELF RULE S
AND REGULATION'S OF THE WATER SVSTE61,AND STATE REGULATIONS
G GE CALIBRATICI DATE 02-28-2023 DETECTOR METER READING
1G
Dane Yalla 12087777688 State Testers
Darnall Sprinklers Certification #BAT-25372
3172 W Setice Way Post Falls, ID 83854 Gauge# 01191100
REPORT RECEIVED BY ® SERVICE RESTORED
0 FOUND OFF,LEFT OFF

New
Xa Existing
BACKFLOW ASSEMBLY TEST REPORT Removed
Replacement
Property Glen marble
Owner
Mailing 284 stewart Blanchard, ID 83804
Address Phone
Assembly 284 stewart Blanchard, ID 83804
Address
= R P B A C] D CV A a RPDA aDC DA ® PV BA rl SV8AOAVB a AIR GAP
SIZE 1 " MAKE: Wilkins MODEL: 720A
Water Purveyor Stoneridge Prop. Water District Serial # CB871237
Assembly Location: Next to water mete
REDUCED PRESSURE ASSEMBLY DOUBLE CHECK P V B A : S V B A INITIAL TEST
01 CHECK
INITIAL PRESS DROP (A) CHECK 91 PASSED
INLET ET CHECK
TEST RELIEF VALVE TIGHT (3 OPENED PRESSFAILED
RESULTS OPENED AT MIN 2PSID (B) LEAKED [3 PSID AT DROP] DnATTE/�
BUFFER PSDI PSDI 0�l_0.8_'24
A-B CHECK 02
BYPASS MIN 3 PSI
TIGHT 13
CHECK RELIEF VALVE DID NOT OPEN FAILED SYSTE1':1 Pti'r-ASS ❑ FAIL 13 LEAKED PSID 13 13 80
C Oki M ENT';
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D.0 V A P V B A ' S VBA
AFTER
TEST
41 CHECK CHECK 01 REPAIRS
AFTER PRESS DROP (A) TIGHT pSID OPENED PRESS
REPAIRS RELIEF
0 Ar oR,�P DATE
OPENED (0)
MIN 2PSID CHECK 42 PSDI PSDI
BUFFER TIGHT pSlp
A-B
MIN 3 Psi 0 PASSED [3
IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE'ESTER CERT,FES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM.AND STATE REGULATIONS
GAUGE CALIBRATI N DATE 02-05-2024 DETECTOR METER READING
-0. -//Yy
jF I NAT
y or Fulwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
REPORT RECEIVED BY ❑ SERVICE RESTORED
❑ FOUND OFF, LEFT OFF

F-lNew
ElExisting
BACKFLOW ASSEMBLY TEST REPORT E-] Removed
Replacement
roperty Glei marble
Uwner
Malting 284 stewart Blanchard, ID 83804
Address phone
Assembly 284 stewart Blanchard, ID 83804
Address
a R P B A [:]U+-V A a R P 0 A [D D i.0 A ® P V 0 A Q V 0 A®A V R AIR GAP
SIZE 1° MAKE Wilkins MODEL 720A
Water Purveyor Stoneridge Prop. Water District Serral a CB871237
Assembly Location Next to water mete
INITIAL TEST
CHECK AIR INLET CHf!:K
INITIAL RESS DROP _ ,A) CHECK $1 PASSED 10
TEST '<ELIEf VALVE TlfsliT a OPENED aR FAILED ❑
RESULT`` '-PENEDAT (0) LEAKED a PSID IT DRrP DE
IN (J p n DATE
AT
..IJFFER M 2 PSID PSDI r'561 05,2V. 123
A.0 - CHECK 02
BYPASS MIN 3 PSI
RELIEF VALVE I TIGHTt -+ NOT FAILED SYSTEM PSI
CHECK ❑ N ❑ ❑ 45
P 455 ❑ FAIL a LEAKEf-
COMMENT
REPAIRS
AND/OR
PARTS
•,I DUC17 D PRF SSURF ASSFUSI N P V B A
AFTER
TEST ,I CHECK REPAIRS
AFTER ;RESS DROP (AI i nw OPENED PRE 55
-'rPAIRt, �,£u£r
a AT DROP DATE
;PENfD (a) PSDI PSDI
MIN 2 PSID r' a2
'tUFr£R III PSID
" e - WIN 5- - a PASSED ❑
IN COMPLE I-NG AND SUBMIT TING THIS TEST REPORT,THE TES TER CERTIFIE S THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SY.CTFM,AND STATE REGULATIONS
GAUGE CALIBRATION DATE 02-28-2023 DETECTOR METER READING__ _
#R S+GNA-URE
James Williams 12087777688 side Testers
Darnall Sprinklers Certification 4 Bat-16583
3172 W Setice Way Post Falls, ID 83854 Gauge# 12091184
REPORT RE CEIVEG EY
® SERVICE RESTORED
❑ FOUND OFF,LEFT OFF

QNew
aExisting
BACKFLOW ASSEMBLY TEST REPORT 1:3 Romoved
Replacement
Pat Patterson
`�y,•ner
285 Stewart Dr Blanchard, ID 83804
Address
Phone [phone]
AssemblV 285 Stewart Dr Blanchard, 1D 83804
A.idress
O '' .- VA [Z] VA O Al A 1:3 co,& Q - V nA Qi'vIsACoAv0 AM 4UP
s�lr 1" MAKE Febco MODEL 850U
'evater Purveyor stoneroage Prop. Water District S*rral 0 H 14094
A%Eombly Location right side of house
t ou"D 671%4 wtc W INITIAL TEST
IN IT tAL ar]Is areoP —.. a cs�+.• r ASS EC
TEST - 0EF VALVE K
� W ® ,t.1 I'Th n PFWSG FAILED 13
RESULTS �'tityED AT �Alfi a vs1 it, EAPED 13 PaiD AT 010tw DACHECK 92 PS P50 TE
// 5 ..{{pp
BYPASS lrr+T fArLvo S'r'STEM PSI
CHECK
Atl*F ►'Al lE ® 1 .8 I1.
Ass p p cmrc Q .cM 0 © 46
COMMENTS
REPAIRS
ANWOR
PARTS
eel)PRFS uw A153f W A V a A
1-EST AFTER
AFTER vUoR0 ,A., 10 r++f P&Uu CWEN4a =c.BS REPAIRS
REPAIRS HEUEt 13 AT -ap DATE
DrlEJCi� f�0 i _ '
MMIi 7K1 L'.NFU1 r2 >af I Palk ---
lkMftR T1i3HT MCI
• N
„Psi PASSED D
Kr r.-rjIAP,ET0VG Ar10 61191141M Tina rest 11WOORT,THE TESTM CERTWjeiR THAT
1#if AErSEMSLY#A"OfIEN Tf. TEa AND YWWAOCO tN ALCCIALA/VGL'WITTY ALL A.PUCANLE FOAA5
ANGRPGULAVrONAU WAttR8V%r U AW9TATEREGUtATtOW
T1 E t_4I.ISRAT [)Alf_ 02-28-2023 DETEC7ORMrtE104 READ;NG_ _
Dane Yalian 12087777688 State Testes
Darnall Sprinklers ce"Ificahon it BAT-25372
3172 W Setice Way Post Falls. ID 83854 Ga ge s 01191100
® SERVICE RESTORED
0 FOUND OFF, LEFT OFF

2aC 5�
New
171 Existing
BACKFLOW ASSEMBLY TEST REPORT Removed
aReplacement
Property Pat Patterson
Owner
Mailing 285 Stewart Dr Blanchard, ID 83804
Address Phone [phone]
Assembly 285 Stewart Dr Blanchard, ID 83804
Address
O K P H A ® D C.V A a R P D.A =) D C D A O P V B A [::] S V B.A. A V B. [:]AIR GAP
SIZE. 1 " MAKE: Febco MODEL: 850U
Water Purveyor Stoneridge Prop. Water District Serial # H14094
Assembly Location: right side of house
REDUCED PRESSURE ASSEMBLY )UBLE CHECK P 'v B A S E A INITIAL TEST
at CHECK AIR INLET CHE_K
INITIAL PRESS DROP (A) CHECK 91 TIGHT PASSED
TEST RELIEF VALVE ® 1 .8 OPENED PRESSFAILED
RESULTS 13
OPENED AT MIN2PSID (B) LEAKED Q PSID AT DROP] DATE�p �^
BUFFER PSDI PSDI 05/ '24
A•B - CHECK M2
BYPASS MIN 3 PSI
CHECK �'EUEF VALVE TIGHT ® 2.1 DID NOT FAILED SYSTEMPSI
OPEN A
PASS [3 FAIL 0 LEAKED PSID 0 Q 7C]
COMMENTS
REPAIRS
AND/OR
PARTS
REDUCED PRESSURE ASSEMBLY D.0 V A P V B A r S V B A
AFTER
TEST
ai CHECK CHECK at REPAIRS
AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS
REPAIRS RELIEF 13 AT _tRt>P DATE
`PENED (B)
MIN 2 PSID CHECK 42 PSDI PSDI
BUFFER TIGHT pglD
A-B - PASSED 13
MIN 3 PSI
IN COMPLETING AND SUBMI-TING THIS TEST REPORT,THE-ESTER CERTIF ES THAT
THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES
AND REGULATIONS OF THE WATER SYSTEM,AND STATE REGULATIONS
GAUGE CALIBRATI N DATF 02-05-2024 DETECTOR METER READING
-- �..�NA-1-
Taylor Fulwiler 12087777688 State Testers
Darnall Sprinklers Certification # BAT-23282
3172 W Setice Way Post Falls, ID 83854 Gauge # 02120756
REEPORT DECEIVED Br ❑ SERVICE RESTORED
❑ FOUND OFF, LEFT OFF
��1

Customer/Business Name: Bryce Myrva ng Dwe. 6/14/2023
Assembly ScrviccAddress: 231 Stoneridge Road, Blanchard
Locution ofAsscmbN: Left front by meter
Type ofIIdzurd Control led: Lawn Sprinklers ,�A <
AsscTnbly infix-Make: W kI Model 0: QQ /'I Serial N: O J.�
(circle) RPBA RPDA CV DCDA PVR SVB r/
Size In): I,inr Presvurc:(PSI):
installation:horizontal: Y N Vertical: VU VD Other:
iurde) New Y N
Replacrs Serial#:
Check V•Ive Nt Check Valve#2 Relief Valve PVB/SVB Shut Off Valve%
/ �Ay #t #z
Initial Held at�PSIDLIcIrd at ram' PSID ❑ Opened at ❑ Air Inlet opened atTestClosed Tight ed Tight PSID PSID Closed lightLeaked ed ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ RFPPLACED ❑ REPLACED ❑ REPLACED: ❑ RLpJw .ED
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spnng ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Scat ❑ Seat ❑ Seat ❑ Check Spring
e ❑ Ilinge Pin ❑ Hinge Pin [] O-Ring(s) ❑ O-Rings)
G
❑ Module ❑ Modulo ❑ Module ❑ Guide
❑ ❑ ❑ ❑
NOTES:
Final Closed Tight Closed'I'igM ❑ Opcncd At Air Inlet PSIll Shutt)tT Valves I k
Test PSID PSID PSID CK Valve PSID Closed"fight Cx
NOTE Purveyor must be notified with _24 hrs of any baekflow prevention assembly left in a failed(non-passing)condfti6h.
Ttster's Name(please print): Edward Horn _ _ iD BAT License# 23861
Company Namc: Advanced Sprinklers _ _ Expiration Date: 1/6/2024
Company Phonc: 208-687-1955 Fttx#� 208-687-2625
Test Equipment Make&Model: Midwest 845 Serial#: 11071676
calibrated By: BAT Calibration Date: 3/11/2023
1 certify the assembly was tested in acordanee with U.S.0 test protocol and was in working condition.
t .t Passed Fair ❑ Assembly as Left: Service Restored BAT Tae Attached
ti ven r-f� Date
(bp9 of Report to: Customcr/Otvnc-LIn Water Purveyor Licensed fester
Water PurveNr)r StoneridgTe- 7

Customer i Business Nutne: Bryce Myrvang Date: 5/30/2024
Assembly service Address: 231 Stoneridge Road, Blanchard
Location of Assembly: Left front by meter
Typeol'HazardControlW: Lawn Sprinklers
Assonbly info-Make: WattS Modci#: 007 MiQT Serial#: 83055
(carte) RPRA RPDA DC'DA PVR tiVR Size(In): tin l.inc Pressure(PSI):
Installation:Horizontal: ` N Vertical: VU VD OthK
react•) New: Y Replaces Scnal#:
Check Valve 01 Check Valve#2 Relief Valve PVBWR Shut Off Valves
MI #2
Initial Icl at PSIDki.l.
at PSID ❑ Opened at ❑ Air Inlet opened at
test 'losed Tight d 1 rght KID PSID Closed light
❑ L"ked ❑ 1 eked ❑ Opened I WIN ❑Opened Fully
❑ Did Not Open ❑ Did Not Open I'Ukcd ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑CLEANED ❑CI.F.ANFI) ❑ CLEANED ❑ CLEANED CLLANED ❑ ❑
❑ REPLACED: C] REPIACED: ❑ REPLACED ❑ KETLACLR
❑ Disc ❑ Disc ❑ Disc ❑ Poppet I Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Sprng ❑ Air Inlet Spring
❑Guide ❑ Guide ❑ Guide ❑Check Disc
C] Seat ❑ Seat [] Seat ❑Check Spring
❑Ilinge Pin ❑ Hinge Pin ❑ O-Rng(s) ❑O-Ring(s)
C
p� C] Module 0 Module ❑ Module ❑Guide
o� ❑ ❑ ❑ ❑
x NOTES:
Final lottsJJed Tight ns5d I$ght ElUpvned.4t Au Inlet PSID Shut off Valvesvai # #2
Test r —1 PSID _PSID PSID Cie Valve PSID Closed"Ilght [
NOTE:Purveyor most be notified within 24 firs of any backflow prevention assembly left in a failed(nun-nassintt)condition.
Testers Ntime(please print): Josh Mitchell ID BAT License#: 19350
Company Nrane: Advanced Sprinklers Expiration Daic: 1/1 0/2025
Company Phone: [phone] I:ax#: 208-687-2625
Test Equipment Make&Model: Midwest 845 serial#: 1120969
Caiibrated By: BAT Calibration Date: _3/6/2024
1 certify the as ly was tested in acordance with U.S C test protocol and was in working condi n
Tes� s: Passed Faded ❑ Assembiv as Left: Service Rcstomd�ZBA'I T'aa Attached
i`
of Tester Dare
Copy of Report to: C'usrumed(hvncr N'atrr Pun qnr Licensed Tester ]
Water Purveyor _Stoneridge _ G
Nnnh Idaho RegumW Wata Pun ww Backllow Au mW Tot Report NIR),%PO•AM.6S

Zf!, c� 50nu d9e.
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME Cc C�, n r
SERVICE ADDRESS as 5' Vjcr z.. u/►C��i4. )� CI
LOCATION OF ASSEMBLY Cf` S -« L 7
SUPPLY
TYPE OF ASSEMBLY P NEW INSTALL PSI 6 (j
MANUFACTURER (L MODEL C)V7M OT SERIAL C,-7 SIZE /
PVB/SVB
CHECK VALV u 1 CHECK VALVE 9 2 RELIEF VALVE AIR INLET OPENED AT_ -
HELD AT_. PSID HELD ATE �PSID OPENED FULLY r.
INITIAL TEST CLOSED 1 IGHT a CLOSED TIGHT u OPENED AT PSID DID NOT OPEN
LEAKED n LEAKED d DID NOT OPEN CHECK VALVE HELD AT
LEAKED L
CLEAND r CLEAND
CLEAND r CLEAND �
REPLACED REPLACED ❑ REPLACED c REPLACED
REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT PSID AIR INLET OPENED AT_ _PSII)
CLOSED TIGHT c CLOSED TIGHT DID NOT OPEN CHECK VALVE HELD AT
LEAKED n LEAKED n —
PASS FAIL
NOTES
GAUGE a MAKE AND MODEL CALIBRATION l)AlE
TESTER LICENSE DATE
REPAIRED BY DATE
FINAL TEST BY T�j t^J J .1 LICENSE "r l j 3 DATE
WATER PURVEYOR 5 vn A1 1,✓a r CAMef
Nash 8� Son RPM
f
208.500.9747
Call or Text for an Estimate
�,z

Water � ((���� File
Purveyor:V l U n �� Q�. V I I t No:
-
Service Address of assembly 2�)S S Yl voad
Location of assemblyon premise
Supple to: U YI n K i a
(honer of assembly: C.0 1 I Y1 ll
Owner address: 001--ban Lb ar7AZIP Q o l
Manufacturer: Model No:�7y1/ ce' Size_LSerial a(.&ky7
St),le: RP O DCI� DCDA O RPDA O PVB O SVB O Orientation
New System Pressure
insta/I Reduced Pressure Principle Assembly at this location
Y � _ PSI
Double Check Valve Assembly 5-2?
CYrec•k Valve# l �17CheckVal�ve#2 Relief Valve rf PVB/SVB
INITIAL lleld at /I Z PSID lleld at / /' PSID Air inlet
TEST Opened at PSID opened at
Closed light-�J- Closed light PI
Did not open O Opened Fully O
Leaked O Leaked O
Did not o en O
Check valve
Cleaned O Cleaned O Cleaned 0 held at
REPAIRS Replaced O Replaced O Replaced O Leaked L7
Cleaned O
Replaced O
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked O Leaked O
Did not open O Check Valve
Comments:
Initial test by: Chris N Q S 1" I Date: �9 1 U ' J?
Certification/License# 1314T 2041b Pass Fail O
Repaired/Cleaned by Date:
Final Test by: Date:
Certiftcation/License# Pass C Fail O
Water service restored? N
BAT Form—pk I.W

2618 �b►���dc�e r2�t
Customer/Business Name: Ron Burns Date 5/11/2023
298 Stoneridge Rd — - - -----
Assembly Service Address: Blanchard,ID 83804
Location of Assembly: I
C,
Type of Hazard Controlled:
Assembly info- Make: ® Serial#-gAt<
RPBA RPDA DCVA DCD �PVSVB Size(In): Line Pressure(PSI):
Installation:Horizonta N Vertical:VU VD Other: J—
New: Y rF)
Replaces Serial #:
—— Cheek Vtttv_e_01_ Check Valve#2 —�--Relief Valve T PV8lSVB Shut Off valves
Initltd ❑ Held at PSID Held at PSID ❑ Opened at od at #1 i2
Test ❑ Closed Tight Closed Tight PSID C� PSID Closed Tight
❑ Leaked Leaked Opened Fully Opened Fully
i
[] Did Not Open ❑ Did Not Open Lealted ❑ ❑
[heck held at
ZIL PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ RF-PLAM: ❑ RWJLACED: ❑ REPLACER; ❑ Rt:Pr AU&
❑ Disc [] Disc ❑ Disc ❑ Poppet/Flow REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
t� ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
Q ❑ Hinge Pitt ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Ring(s)
a ❑ Module ❑ Module ❑ Module ❑ Guide
a ❑— ❑. - ❑ ❑
NOTES: ---- — ----
Float ❑ Closed Tight ❑ Closed Tight —�—❑ Opened At Air Inlet PSID Shut OK Valves #1 #2
Tqt PSID PSID PSID CK Va1ve?. � PSID Closed Tight Q�
NOTE:Purveyor must be notified withis 24 brs of any backrlow prevention assembly left In a railed(non-passing)coodidon.
Tester's Name(please print):RICHARD STAFFORD ID BAT License#: 18145
Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/25/2023
Company Phonc: 208-818-8838 Email:
Test Equipment Make&Model: MIDWEST 845 Serial#:02191467
Catibratcd By: B.A.T.& SUPPLY Calibration Date:09/24/22
I certify the ttutt:em was tasted in scordsnee with U.S.C.im protocol and weir in werkmp condition
lesn Reantta: passed
-- — ad Assembly as Left: Water Set-
ce Retoe�/ BAT Tap ntrchedo ❑ a
SweofTefter Due
PuoCopv of Report to; cuvomer,OWCT water Licened Textet Q
Water Purveyor:

Customer/Business Name: Ron Burns Date: 5/9/2024
298 Stoneridge Rd
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: Right Side
Type of Hazard Controlled:
Assembly info-Make: Wilkins/720A* Serial# T588205
RPBA RPDA DCVA D A<@� SVB Size(In): Line Pressure(PSI):
Installation: Horizunt. N Vertical: VU VD Other:
New: Y Replaces Serial #:
Cheep_Valve#1 heck Valve#2 -- Relief Valve - __ - / PVB/SVB Shut OR Valves —
I Initial ❑ Held at PSID ❑ Held at PSID ❑ Opened at J Opened at #1 #2
'rest ❑ Closed Tight ❑ Closed Tight PSID 2 PSID Closed Tight
❑ Leaked ❑ Leaked ❑ Opened Fully Opened Fully
❑ Did Not Open ❑ Did Not Open Leaned ❑
k held at
' )PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ Cl
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ seat ❑ seat ❑ Seat ❑ Check Spring
G ❑ Hinge Pin ❑ Hinge Pin ❑ n-Rings) ❑ O-Ring(s)
a ❑ Module ❑ Module ❑ Module ❑ Guide
CG NOTES: - -L
Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air inlet PSID Shut Off Valves #t #2
Test PSID PSID PSID CK Valve PSID Closed Tight
NOTE:Purveyor must be notified within 24 brs of any backflow prevention assembly left in a failed(non-passing)condition.
Tester's Name(please print): b*N-R4&&& `""� /.,,t 1D BAT License#: klt' S�
444
Company Name: SPRINKLERS NORTHWEST Expiration Date:4f20 2e_"— p Z S Z y
Company Phone: [phone] Email:
Test Equipment Make& Model: /�f� 1,� �— Serial#:02AC+20#MTI Z I f 4 (z f
Calibrated By: MAKV--, A�� � Calibration Datc:09/21/2023
1 cenify the tusetn^- waa tested in acardanee with U.S.C.test protocol and was to w mg condition
Test Results: Passed railed ❑ Assembly as Leh: Water Service Restored[!] 8AT Tap AttschA1T_*_,
/ - - Dare 7 � —
l.raatwe of l ester `.�
Coov of Retort to: Custorner/owner ❑ water Purveyor ❑ Licensed Tester ❑
Water Purveyor: Stoneridge

Customer/Busines..Name: Vicki Epp Date: 5/9/2024
299 Stoneridge Rd
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: in garage behind water heater
Type of Hazard Controlled:
Assembly info-Make: Serial# 3o 2.--5
RPBA RPDA jqDCDA PVB SVB Size(in): Line Pressure(PSI): ys
installation: Horizont.}. N Vertical: VU VD Other:
New: Y �N Replaces Serial M:
Check Valve NI Cbeck Valve ft: Relief Valve PVB/SVB Shut Off Valves#1 T N2_
Initial i/ ld at f/ PSID [/ d et fi PSID ❑ Opened at ❑ Opened at
Test Closed Tight Closed Tight PSID PSID Closed Tight
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
[] Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED M ❑
(] REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Seat ❑ Check Spring
G ❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Rings)
❑ Module ❑ Module ❑ Module ❑ Guide
wa ❑ ❑ ❑ ❑
tY NOTES:
Final ��/ose Tight fose' ight ❑ Opened At Air Inlet PSID Shut OR Valves- #1 #2
PSID PSID PSID CK Valve PSID Closed Tight
NOTE.Pur%eyor must bXnod:wIbin24hrs f any b ow prevention assembly Ieft Ina failed(non-passing)condition.
t �47Tester's Name(please print): ` ! ID BAT License#�,233(z�-, V
ZK
Company Name: SPRINKLERS NORTHWEST Expiration Date:4 D Z
Company Phone: [phone] Email:
Test Equipment Make&Model: `NI7{2Z0'M*5- nil j U f tnerial#:
Calibrated By: Irtr K10 Calibration Date:09/21/2023
I ceruty the arse- b was tested m acunlame with t:.S.C.test1r otecol turd was in wor on
Test Results: Passed F sled ❑ Assembly as Len: water Service Res BAT Taa Atuctted
S'Sauue o1 I Date
Coov of Report to: CustomerlOwnet ❑ Water Purveys ❑ Licensed Teste, []
Water Purveyor:

Customer/Business Name: Mike Hicks Date: 5/11/2023
299 Stoneridge Rd -- —
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: in garage behind water heater
Type of Hazard Controlled: ./ n:
Assembly info-Make: GL, Serial# `-7 02 S
RPBA RPDA V DCDA PVB SVB Size(In): Line Pressure(PSI):
Installation:Horizontal N Vertical: W VD Other:
New: Y ! N Replaces Serial #:
Cheek Valve 01 _Check Valve NZ _ Relief Valve PVB/SVB Shut Off Valves
r #1 #2
lnithl H lei aPSID '`" SID ❑ Opened at ❑ Opened atTeat � tted Tight PSID I PSID Closed Tight
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaky ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED
❑ FC>rPI_QD.
_ ❑ REK AMA ❑ PLACED. ❑ KUL—LAGEQ ❑ ❑
❑ Disc ❑ Disc ❑ Disc ❑ poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
❑ Guide ❑ Guide ❑ Guide ❑ Check Disc
❑ Seat ❑ Seat ❑ Scat ❑ Check Spring
❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Ring(s)
❑ Module ❑ Module ❑ Module ❑ Guide
NOTES:
Final i Closed Tight Closed Tight Opened At Air Inlet PSID Shut Off ValveTCA
Test PSID crPSID PSID CK Valve PSID Closed Tight ,L,LJ
NOTE:Purveyor most be notified within 24 hrs of any bacictlow prevention assembly left in a failed(non-passinit)condition.
Tester's Name(please print): RICHARD STAFFORD ID BAT License#: 18145
Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/25/2023
Company Phone: [phone] Email:
Test Equipment Make&Model: MIDWEST 845 Serial#:02191467
Calibrated By: B.A.T.& SUPPLY Calibration Date:09/24/22
Iccrtifjthessw,ijW was testcd in acordanu widt U.S.C,test protocol and was in working condition.
Teat Results: Passed IK Fail ❑ Aaserably as Left: Water Service Restored[/BAT Tap Attached
i
Copy, of Report to: Cutotner/Owner [] Water Purveyot ❑ Licenxd Taster ❑
Water Purveyor:

Customer/Business Name: Kenny Green Date: 5/9/2024
312 Stoneridge Rd -- -
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: L side shop
Type of Hazard Controlled:
Assembly info-Make: Qj Serial#:t5LZ03Z
RPBA RPDA DCVA D(' A SVB Size(In): Line Pressure(PSI):
Installation: Horizon N Vertical: VU VD Other-
New: Y Replaces Serial #
Check Valve Iil Check Valve 42 Relief Valve PVB/SVB Shut Off Valve_
Initial ❑ Held at PSID ❑ Held at PSID ❑ Opened at LdOpt:nod at #1 82
Test ❑ Closed Tight ❑ Closed Tight PSID z' PSID Closed Tight [
❑ Leaked ❑ Leaked ❑ Opened Fully „/f-ed Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
heck held at
GIS PSID
❑ Leaked
❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED { ❑ ❑
❑ REPLACED: ❑ REPLACED: ❑ REPLACED: REPLACED:
❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring
�] Guide ❑ Guide ❑ Guide ❑ Check Disc
t+i ❑ Seat ❑ Seal ❑ Seat ❑ Check Spring
Q ❑ Hinge Pin ❑ Hinge Put ❑ O-Ring(s) ❑ O-Rings)
a ❑ Module ❑ Module ❑ Module ❑ Guide
oW�. ❑ ❑ ❑ ❑
of NOTES:
Final ❑ Closed Tight ❑ Clotted Tight ❑ Opened At Air Inlet PSID Shut Off Valves #1 #2
Test PSID PSID PSID CK Valve PSID Closed Tight
NOTE:Purveyor must be noti within 24 brs ol any backflow evention assembh,left in a failed(non-passinst)condition.
t LA T-7
Tester's Name(please print): 5/zID FEAT License
Company Name: SPRINKLERS NORTHWEST Expiration Date:41"2M /0 Z 5 •may
Company Phone: [phone] Email:
Test Equipment Make&Model: •MP[!t$iv!{f5 j Serial#: V
Calibratcd by.A4AKO— Calibration Date:09/21/2023
1 certify the it hl ss tested in accirdsnce with 11.S-C test protocol and was Inworking condition
Test Results: Passed Failed ❑ Asserably as Left: Water Service Restored; BATTaR Attached
Sgnanue of Terrer ?41�4� Dare
Copv of Repay to: CuatomedOwner ❑ water Purveyor ❑ Licensed Tester ❑
Water Purveyor:
—Q

Customer/Business Name: Kenny Green Date: 5/11/2023
312 Stoncridge Rd
Assembly Service Address: Blanchard, ID 83804
Location of Assembly: L side shop
Type of Hazard Controlled: j f
Assembly info-Make: , � S 2 (2) Serial#
r—
RPBA RPDA DCVA DCDA PVB )SVB Size(In): Line Pressure(PSI):
Installation:Horizon4:�/r N Vertical: VU VD Other:
New: Y v Replaces Serial #:
Check Vol"01 CbeckValve#2 1 Rellefvalve PVWSVB shatoffvahw
lnitW ❑ Held at PSID ❑ Held at PSID ❑ Opened at ❑ Opened at #1 #2
Teat ❑ Closed Tight ❑ Closed Tight PSID PSID Closed Tight ef
❑ Leaked ❑ Leaked ❑ Opened Fully ❑ Opened Fully
❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑
❑ Check held at
PSID
❑ Leaked
❑ CLEANED ❑ CLEANED [] CLEANED ❑ CLEANED CLEANED ❑ ❑
❑ Disc [] Disc ❑ Disc [] Poppet/Float REPLACED ❑ ❑
❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Sprang
❑ Guide ❑ Guide I ❑ Guide ❑ Check Disc
❑ Sat [] Seat ❑ seat ❑ Check Spring
O ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(e)
❑ Module ❑ Module ❑ Module ❑ Guide
aW ❑-- - ❑ -- ❑ ❑.— - ---
ot NOTES: —
Firm! ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet PSID Shut Off Valves #1 #2
Test PSID I PSID PSID CK Valve PSID Closed Tight
NOTE:Purveyor must be notified within 24 bra of any backnow prevention assembly left in a failed(nos-paaalaA)coadltloa.
Tester's Name(please print):RICHARD STAFFORD ID BAT License#: 18145
Company Name: SPRINKLERS NORTHWEST Expiration Date: 10/2.5/2023
Company Phone: [phone] Email:
Test Equipment Make&Model: MII)WFST 945 Serial N: 02191467
Calibrated By: B.A.T.&SUPPLY Calibration Date:09/24/22
i certify the ansemb was tested in wordaace with U.3 C.tat protocol and was in working condition.
Test Recurs: Passed Failed ❑ Assembly as Left: Water Sen ice Restored BAT Tag Attache 1
Siaan�n of Tuner Data
Copy of Report to: CustomerlOwner ❑ Water Purveyor ❑ Lic.W Tester ❑
Water Purveyor:

3-70 5�►�-e�r 1�`"�J`"
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME " �,. I I I ( ))%
SERVICE ADDRESS 1 )
I L, 5 f [I f L �I : Ile
LOCATION OF ASSEMBLY
SUPPLY
TYPE OF ASSEMBLY D NEW INSTALL Aj PSI
MANUFACTURER , MODEL (2 /" -r SERIAL 0-► I O SIZE
PVB/SVB
CHECK V11LYE#1 CHECK YtLVE#2 RELIEF VALVE AIR INLET OPENED AT PSID
HELD AT PSID HELD AT PSID OPENED FULLY r
INITIAL TEST CLOSED TIGHT> CLOSED TIGHT; OPENED AT PSID DID NOT OPEN
LEAKED r_ LEAKED _� DID NOT OPEN u CHECK VALVE HELD AT
LEAKED
CLEAND rn CLEAND
REPLACED REPLACED CLEAND CLEAND
r,
REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED
CLOSED TIGHT :. CLOSED TIGHT i OPENED AT PSID AIR INLET OPENED AT PSID
LEAKED LEAKED DID NOT OPEN a CHECK VALVE HELD AT
PAS FAIL
NOTES
GAUGE N U�L- I MAKE AND MODEL /�I ��. r N �� CALIBRATION DATE
TESTER G � us LICENSE 2 b DATE
REPAIRED BY DATE
FINAL TEST BY I.ICENSF DATE
WATER PURVEYOR �, I:�11
Nash & Son RPM
A REALTOR •I ANDCCCAPIN(: . F Wr AVATInN
208.500.9747
Call or Text for an Estimate
6�

Water , File
Pumo Water,
JT D n c l _i d g (. U I 1 l i � I cS No:
Sen-ice Address of assemble' 0 V Sim z y 14 Q ��
Location of as':crembl►•on premise t�l I c YY m-1"
Supply to:y r►n K1 c
Owner of assembly: �j o t/
Owner address: MD n e 1Z I d (1 L d 00, 1 (A!--7j Z/P � b
Alanufacturer: ���-1 Model No:C07/1/I �7 Size Serial
Stj,le: RP O DC DCDA O RPDA O P1 B O SVB O Orientation
New System Pressure
Itrstallati t�? Reduced Pressure Principle Assembly at this location
PSI
Double Check Valve Assembhr
Check !'aloe# 1 Check l'alve#2 Relief I'alue PIT/SVB
INITIAL Held at-, He/d at PSID Air inlet
TEST Opened at PSID opened at
Closed tight � Closed tight �-
Did not open O Opened Fully O
Leaked O Leaked a
_ Did not open a
Check value
Cleaned O Cleaned O Cleaned O held at
REPAIRS Replaced O Replaced O Replaced O Leaked O
Cleaned O
Replaced O
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked O Leaked O Did not open O Check Valve
Comments:
Initial test bj,: Chi is N a 1 h Date: 2
Cerifflation/License# UA TIT) 4e) Pacs• Fail O
Repairecl/Cleaned by Date:
Final Test hy: Date:
Certiftcation/Lic•ense# Pass O Fail O
Ff'ater service restore((? Y N
BAT Farm sample 1 W

1-4
BACKFLOVV PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME (;VT
SERVICE ADDRESS f c;.'1'C r, L �3 G�l C Q• 3 C
LOCATION OF ASSEMBLY Fro
SUPPLY �-•/ 1 ` 1
TYPE OF ASSEMBLY NEW INSTALL PSI (�
J 5
MANUFACTURER � / n�i MODEL (�r-/ T- SERIAL �9 ? g 7 Sin
PVB/SVB
CHECK VALVE)tt 1 CHECK VALVE it 2 RELIEF VALVE AIR INLET OPENED AT__ PSI[)
INITIAL TEST HELDAT �. -I PSID HELDAT I V PSID OPENED AT PSID OPENED FULLY
CLOSED TIGHT D CLOSED TIGHT v DID NOT OPEN ❑ DID NOT OPEN
LEAKED c LEAKED n CHECK VALVE HELD AT
LEAKED c
CLEAND n CLEAND n
CLEAND CLEAND
REPLACED o REPLACED a o
REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED
OPENED AT PSID AIR INLET OPENED AT
CLOSED TIGHT Li CLOSED TIGHT
LEAKED c LEAKED o DID NOT OPEN o CHECK VALVE HELD AT--
PASS FAIT
GAUGE MAKE AND MODEL 1 L; CALIBRA[ION DATE ' t
TESTER LICENSE DATE
REPAIRED BY DATE
FINAL TEST BY filu r 1 LICENSE (3 — DATE
WATER PURVEYOR d 4t R '— ��.,y, le
Nash & Son RPM
REAI Top 1 ANfDSCA('INf. • V XCAVAI ION
208.S00.9747
Call or Text for an Estimate
�L

Water (�� J }-, Flle
Purveyor:� I V n �I q ( U I I t No:
Service Address of assembly �� j !n(� (i ( 12(�
Location of assembly on premise { l I 1 r
Supply to. Q n n K i a
Owner of assembly: O CU L I ( I)D � y�
Owner address: 1421 .,1-WI I11 6 q .l 2 6I`
City DULDL i ZIP
Manufacturer: �6 , ,,;s MftW No: L7 Fb,c L i Size [_Serial Z '2 97,9"7
Style: RP C DC DCDA O RPDA C PVB C SVB C Orientation
New System Pressure
Instali�? Reduced Pressure Principle Assembly at this location
Y _ PSI
Double Check Valve Assembly-
--FC_'heck Vulve t3 ! Check Valve h 2 Relief Valve PVB/SVB
INITIAL Held at Z-f P.SID Held at 1, Z— PSID Air inlet
TEST Opener!at P.S/D opened at
Closed fight Bf Closed tight.-C_
Did not open O Opened Fully O
Leaked O Leaked O
Did not open a
Check valve
Cleaned 0 Cleaned O Cleaned Ll held at
REPAIRS Replaced 0 Replaced 0 Replaced O Leaked 0
Cleaned 0
Replaced 0
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked 0 Leaked a
Did not a en O Check Valve
Comments:
Initial test by: Chas N Q S 1' 1 Date: V 23
Certification/License# 13 AT 2-041h Pass\jt Fail 0
Repaired/Cleaned ki, Date:
Final Test by: Date:
Certification/License# Pass O Fail O
Water service restored? N
BAT Form—pk LW

BACKFLOW PREVENTION ASSEMBLY TEST REPORT
CUSTOMER NAME
SERVICE ADDRESS
LOCATION OF ASSEMBLY
SUPPLY
I
TYPE OF ASSEMBLY U NEW INSTALL PSI '
MANUFACTURER C. MODEL CJ �� SERIAL t` �L �I�� SIZE
PVB/SVB
CHECK VALVE##1 CHECK VALVE##2 RELIEF VALVE AIR INLET OPENED AT ( PSID
INITIAL TEST HELD AT PSID HELD AT PSID OPENED AT PSID OPENED FULLY
CLOSED TIGHT _ CLOSED TIGHT L DID NOT OPEN c
LEAKED c LEAKED 71 DID NOT OPEN CHECK VALVE HELD AT
LEAKED❑
CLEAND n CLEAND a CLEAND c CLEAND
REPLACED REPLACED ❑ REPLACED ❑ REPLACED u
REPAIR/FINAL HELD AT PSID HELD AT PSID
CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT PSID AIR INLET OPENED AT PSID
LEAKED r1 LEAKED ❑ DiD NOTOPEN c CHECK VALVE HELD AT
PASS FAIL
NOTES
GAUGE �!. J� I 1, MAKE AND MODEL %' f CALIBRATION DATE Z
TESTER ly��C 1�r �i� LICENSE L, '�E , DATE
REPAIRED BY DATE
FINAL TEST BY I ICENSE DATE
WATER PURVEYOR
Nash & Sorg RPM
HF-AI TOR I ANf1CF'APINf:• F 111AVATICIN
208.S00.9747
Call or Text for an Estimate
c �-

Water f rr v QI , J File
Pummor:
Ao:
Service Address of assembly lip n L d Q V-d
Location ojassemb&on premise It fi h JU�1
supph•to: n K i c►�
Owner of assembly: a I {- rL �70✓�
Owner address: Sq) Lffio RZ d Q L U City ra h (a rz. ZIP 3
1/curu jiu ntre Afode!•ti'o: Size�_Serial
Style: RP O DC O DCDA O RPDA O PVB ��SVB O Orientation
New System Pressure
Reduced Pressure Principle Assembly
Installat•rf ' at this location
Y N S r— PSI
Double Check Valve Assembly
Check Valve# 1 TCheck 1'a/ve#2 Relief Valve PI B/SVB
INITIAL field at PSSID Held at PSID Air inlet
TEST Opened at PS1U opened at
Closed tight O Closed tight O
Did not open O Opened Fulhv 0
Leaked O Leaked O
Did not open O
Check valve
Cleaned O Cleaned O Cleaned O held at
REPAIRS Replaced O Replaced O Replaced O Leaked O
Cleaned O
Replaced O
FINAL Closed tight Closed tight Opened at Air inlet
TEST Leaked D Leaked O Did not open O Check I'alve
Comments:
Initial te's!bl•: C I I C 1 S 'V a j h Date:
Certificalion/Lic•ense# DAT2 2�J Puss• �7 Fail L7
RepairedlCleaned by Date:
Fined Test by: Date:
Certification/License# Pass 41 Fail O
li'ater service restored? N
BAT Form sample I W /