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HomeMy WebLinkAbout20240913SWS to Staff 91 Supplemental Response - Test report 2.pdf RECEIVED Friday, September 13, 20245 ,q OCLn a-1;J- IDAHO PUBLIC BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS j n ; l , ` �, C To LOCATION OF ASSEMBLY r C C+ L v SUPPLY TYPE OF ASSEMBLY NEW INSTALL PSI .5 5 MANUFACTURER ( MODEL 2 O SERIAL r y 3Z SIZE j 1 PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST OPENED AT HELD AT PSID HELD AT PSID OPENED FULLY ,L CLOSED TIGHT o CLOSED TIGHT c PSID DID NOT OPEN DID NOT OPEN LEAKED r. LEAKED c '-� CHECK VALVE HELD AT LEAKED c; CLEAND c CLEAND c CLEAND r_ CLEAND ri REPLACED REPLACED REPLACED REPLACED REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT . PSID AIR INLET OPENED AT PSID CLOSED TIGHT a CLOSED TIGHT DID NOT OPEN a CHECK VALVE HELD AT LEAKED n LEAKED PASS FAIL NOTES GAUGE a L 1 MAKE AND MODEL 1 , / CALIBRATION DATE TESTER l LICENSE DATE REPAIRED BY DATE FINAL TEST BY I I �, I J ,� LICENSE j DATE / 2 L WATER PURVEYOR I v Nasli 8� Sop RPM } '•l ANI'3SICCAVATION 208.500.9 747 Call or Text For an Estimate v Water File Purveyor: t ✓. C/ 1 �t Z _ �'I. - l- . Service Address of assembly `�U`Zj A ti ti' 4✓C/ — Location of auembly on prmise -� Supply to: Owner of assembly: B2 n 4 , 1 — Owner address: Cil} ZIP Manufacturer: Ft 5 C J Model No: ,!fP Size _J _Serial_�{�'�7 (o Stele: RP O DC L3( DCDA O RPDA O PVB O SVB O Orientation New Install Reduced Pressure Principle Assembly �m Pressure Y � of this location �i o PSI Double Check Valve Assembly Check Valve h 1 Check Valve fi 2 Relief Valve PVB/SVB INITIAL Held at I PSID Held at L 2-PSID Air inld Opened at PSID opened at TEST Closed tight � erased tight Did not open U Opened Fully U Leaked O Leaked O Did not o O Check valve Cleaned O Cleaned O Cleaned O held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned O Replaced O f;INAL Closed right Closed right Opened at Air inlet TEST Leaked O Leaked O Did not open 0 Check Valve Comments: { >> - L Initial test by:. •� � / Dale: >, Cerlificalionl cease f.�"7 2 S fi Pass Fail a Repaired/Cleaned by Dale: Final Test by: Date: CertifrcationlUcense!! Pass 0 Fail a Wafer service restored Y)N ml H AT Taro—ir 1 p = New MExisting BACKFLOW ASSEMBLY TEST REPORT Removed Replacement Property Owner Robin Cravens Mailing 403 Hanaford Blanchard, ID 83804 Address Phone 903-941 -9417 Assembly 403 Hanaford Blanchard, ID 83804 Address a R P B A. ® D C V A El R P D A [::] D C D A C] P,V B A [11 S V B.A [:]A V B = AIR GAP SIZE 1 " MAKE: Febco MODEL: 850 Water Purveyor Stoneridge Prop. Water District Serial 0 HF67635 Assembly Location: meter REDUCED PRESSURE ASSEMBLY DOUBLE CHECK P.'v B A SVSA INITIAL TEST a1 CHECK INITIAL PRESSOROP (A) CHECK #1 AIR INLET CHECK PASSED TEST RELIEF VALVE TIGHT ® OPENED PRESe FAILED ❑ RESULTS OPENED AT MIN2PSID (B) LEAKED [3 PSI[ AT DROP DATE SUFFER PSDI PSDI /DB- 24 A,B - CHECK 92 BYPASS MIN 3 PSI TIGHT CHECK RELIEF VALVE 2 '� DID NOT FAILED SYSTEM PSI OPEN PASS a FAIL a LEAKED PSID ❑ ❑ 6Q COMMENTS REPAIRS AND/OR PARTS DUCED PRESSURE ASSEMBLY D C V A PVB A ! S V IS A TEST c CHECK CHECK 01 �,AiL ., AFTER PRESS DROP (A) TIGHT PSID OPENED PRESS AT DROP 4T F REPAIRS RELIEF 13 OPENED (a) MIN 2 PSID CHECK 1$2 PSDI - L i R BUFFE TIGHT pSID A.e - o PASSED [3MIN 3 PSI IN COMPLETING AND SUBMITTING THIS TEST REPORT,THE TESTER CERT,FIES 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 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 DECEIVED eY ❑ SERVICE RESTORED 0 FOUND OFF, LEFT OFF Water } File Purveyor: n.e �. (� q (. U I I I t No: Service Address of assembly. I G�) r (�n a i ai a Location of assembly on premise supply to: D n n K I a Owner of assembly: pT ry-) Owner address: 1 I ZJ �� (1 (� l"� City bi a r)G ZIP—qM-0-11 Manufacturer: (ti, ' ;.�[ tifodel No: ��O �(,7 ,517e_LSerial?TT�? Style: RP O DC DCDA C RPDA O PVB D SVB O Orientation New / Sys[em Pressure Install Reduced Pressure Principle Assembly at this location Y L o PSI Double Check Valve 4ssembly Check Valve# I Check Valve#2 Re/ief Vidve PVB/SVB INITIAL Held at1,_� PSID Held at Z � )PSID Air inlet Opened at PSIU opened atTEST Closed tight O Closed tight O 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 -- Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open C Check 1'alve Comments: Initial test by: Chris N Q S 1 I Date: Certircation/License# 13 AT 204 UJ Pass ' Fail O Repaired/Cleaned by Date: Final Test bv: Date: Certification/License# Pass O Fail O Water service restored? N BAT Form sample LUr BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME T ,1I SERVICE ADDRESS / Q n u U^ LOCATION OF ASSEMBLY � ` L� - h SUPPLY TYPE OF ASSEMBLY �!(� NEW INSTALL PSI G (; MANUFACTURER , j/ �` MODEL 7 Cn x (-T SERIAL S ��� SIZE r PVB/SVB CHECK VALVE#1 CHECK VALE N 2 AIR INLET OPENED AT PSiI �j RELIEF VALVE INITIAL TEST HELDAT %•; PSID HELDAT�_PSID OPENED Al PSID OPENED FULLY e CLOSED TIGHT o CLOSED TIGHT o - - DID NOT OPEN LEAKED ❑ LEAKED n DID NOT OPEN CHECK VALVE HELD AT_ LEAKED❑ CLEAND r CLEAND n CLEAND u CLEAND ❑ REPLACED a REPLACED a REPLACED ❑ REPLACED cs REPAIR/FINAL HELD AT PSID HELD AT PSIO CLOSED TIGHT � CLOSED TIGHT � OPENED AT PSib AIR INLET OPENED AT P> I LEAKED LEAKED ❑ DID NOT OPEN LiCHECK VALVE HELD AT_-_ $ FAII GAUGE p I �. MAKE AND MODEL ��ti t Ll CALIBRATION DATE , TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY yL r, J/� LICENSE +� L C j G DATE ' Z WATER PURVEYOR Nash & Son RPM RFAITOR'•I ANDCCAPrN(:- F YI'AVAnc1N r 208.500.9747 Call or Text for an Estimate oti Wafer �-� FUe Parvtyor: n e I� d a�, U�1 I t,j No: Service Address of assembly_ 4' E Lino h rA -I Location of assembly on premise SUpP&to Bonn Owner of assembly: Qua U von Owner address: 1,) ( `—{an cy f-v r d an r.� I z p qM�L Manufacturer: �.,.i ,'�L Model No: �1 Siu_�Serial J Z 7_� Style: RP C DC�V DCDA C RPDA C PVB C SVB O Orientation New System Pressure Install? Reduced Pressure Principle Assembly at this location Y PSI Double Check Valve Assembly Check Valve#I Check Valve#2 Relief Valve PVB/SVB INITUL Held at PSID Held ar 3 • �(PSID Air inid TEST Opened at PSID opened at Closed tight � Closed fight Did not open O Opened Fully O Leaked O Leaked O Did not open 0 Check valve Cleaned O Cleaned 0 Cleaned 0 held at REPAIRS Replaced 0 Replaced 0 Replaced 0 Leaked O Cleaned 0 Replaced 0 FINAL Closed tight Closed fight Opened at Air Mid TEST Leaked 0 Leaked 0 Did nor open 0 Check Valve Comments: Initial test by: Chris N Q S h Date: d 23 Certification/License# 13 2 q Pass Fad!O Repaired/Cleaned by Date: Final Test by: Date: CertifuationlUcatse# Pass 0 Fail O Water service restored? N BATFa Lmpk LW BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS LOCATION OF ASSEMBLY G; SUPPLY I� [ TYPE OF ASSEMBLY l L NEW INSTALL PSI MANUFACTURER ! MODEL S` SERIAL I S �. SIZE14 / PVB/SVB CHECK VALVE#1 CHECK VALVE#2 AIR INLET OPENED AT PSID HELD AT .?: PSID HELD AT�PSID RELIEF VALVE OPENED FULLY INITIAL TEST CLOSED TIGHT p• CLOSED TIGHT r OPENED AT PSID DID NOT OPEN LEAKED LEAKED ❑ DIO NOT OPEN CHECK VALVE HELD AT LEAKED c CLEAND a CLEAND ❑ CLEAND ❑ CLEAND a REPLACED REPLACED u REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED CLOSED TIGHT CLOSED TIGHT ❑ OPENED AT PSID AIR INLET OPENED AT PSID LEAKED LEAKED DID NOT OPEN o CHECK VALVE HELD AT `PASS FAIL NOTES GAUGE# �� MAKE AND MODEL �C �'SZ y S CALIBRATION DATE TESTER fil CI tj , LICENSE DATE REPAIRED BY J DATE FINAL TEST BY LICENSE DATE WATER PURVEYOR Nash & Son RPM p REALTOR •LANFTGCAVIN(a•Fxc•AVAT1C)N- -J. 208.S00.9747 4 Call or Text for an Estimate uti Water File Purveyor: n e ���� No: Service Address of assembly d J l�," i f (l I )(I f Location of assembly on premise Ty l r Supple to: (S D YI n K I a Owner of assembly: 'q124- Owner address: �� N �1�(�� 1 (� 0- City WnL I ZIP_-��L�L_L Manufacturer:—LI--ti L, 7 Model No: 1 SY Sym-4—Serial -2 //p-7 Style: RP O DC O DCDA O RPDA O PVB O SVB L7 Orientation New System Pressure Install Reduced Pressure Principle Assembly at this location Y LNPSI Double Check Valve.assembly —TT—I I --FCheck !Valve#17 T7e7ck 'ae#h� 2 Relief Valve PVB/SVB INITIAL Held at PsID Held at?- PSID Air inlet Opened at ^11) opened at TEST Closed tight � Closed tight Did not open O Opened Fully O Leaked O Leaked D Did not open O Check valve Cleaned O Cleaned 0 Cleaned L7 held at REPAIRS Replaced O Replaced O Replaced O Leaked O Cleaned L7 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 ► l Date: �9 1 d 23 Certification/License# 13 AT 2-0 4 b Pass11 Fail O Repaired/Cleaned by Date: Final Test by: Date: Certification/License# Pass C Fail O Water service restored?6N BAT F——plc LW BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS A LOCATION OF ASSEMBLY SUPPLY �r / TYPE OF ASSEMBLY l` NEW INSTALL PSI MANUFACTURER MODEL SERIAL 1 �7 �I L)� SIZE PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID HELD AT_ .) PSID HELD AT J.q PSID OPENED FULLY 1. INITIAL TEST CLOSED TIGHT O CLOSED TIGHT tl OPENED AT PSID DID NOT OPEN _ LEAKED ❑ LEAKED DID NOT OPEN ❑ CHECK VALVE HELD AT LEAKED u CLEAND a CLEAND ❑ REPLACED u REPLACED Li REPLACED r CLEAND ❑ REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED A7 -PSID AIR INLET OPENED AT _PSID LEAKED n LEAKED n DID NOT OPEN a CHECK VALVE HELD AT PASS FAIL NOTES GAUGE p C �,�' MAKE AND MODEL / �.�- - CALIBRATION DATE TESTER �� / /(JC./� LICENSE ,� �) DATE 7 REPAIRED BY DATE FINAL TEST BY LICENSF DATE WATER PURVEYOR Nasal & Son RPM RFALTOW•LANDSCAPING,EXCAVATION. 208.500.9747 Call or Text for ari Estimate �v Water, � File Pumr*or:�I v n e Q t V I I t L No: Senrice Address oJ'assemhh' � 0 LIE), J S Dr. Location of assemhly on premise En nt sumo to: S D n n K I a Owner of assembly: cJ n n C( �j Owner address: u n K( b r` Cio'_DA n r ar-G1 ZIP Q�90i Manufacture model No: 7 2 tt L-7 size --,I—Serial Z7(o Z ce_z- Stele: RP O DC,' DCDA O RPDA O PVB O S[-B O Orientation New System Pressure Itrstallc Reduced Pressure Principle Assemble at this location y LN PSI Double Check Valve Assembly Check 1'alve# 1 Check 1'ahe#2 Relief{'aloe PVB/Sf'B INITIAL Held at 2 PSID Held at 2' PSID Air inlet TEST Opened at PSID opened at Closed fight 7& Closed tight Did not open O Opened Ful(y 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 Cleaned O Replaced a MAL Closed tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check 1'alve Comments: Initial test ht': C h r i s N Q S 1 1 Date: Cerlific•ation/License# T AT 204Od Passlo Fai10 RepairedlCleaned by Date: Final Test by: Date: Certiftc•ation/License# Pass O Fail O {Pater service restored? N BAT Form sample IM BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS LOCATION OF ASSEMBLY .- SUPPLY J { L I TYPE OF ASSEMBLY NEW INSTALL PSI MANUFACTURER 'S MODEL I ) SERIAL 71 SIZE PVB/SVB CHECK VALVE#1 CHECK VALV�#2 RELIEF VALVE AIR INLET OPENED AT PSID HELD AT PSID HELD AT s• > PSID OPENED FULLY INITIAL TEST CLOSED TIGHT a CLOSED TIGHT a OPENED AT PSID DID NOT OPEN LEAKED r: LEAKED ❑ DID NOT OPEN CHECK VALVE HELD AT LEAKED o CLEAND r. CLEAND zi REPLACED o REPLACED CLEAND ❑ CLEAND n REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED c, REPLACED CLOSED TIGHT � CLOSED TIGHT � OPENED AT PSID AIR INLET OPENED AT PSID LEAKED r LEAKED r. DID NOT OPEN CHECK VALVE HELD AT PASS FAIL NOTES / C CALIBRATION DATE GAUGE# j ? '� G� / MAKE AND MODEL TESTER %� � LICENSE DATE REPAIRED BY DATE FINAL TEST BY LICENSE DATF WATER PURVEYOR r Nash & Son RPM REAL TOR •LANDSCAPING• F XCAVATION 208.S00.9747 Call or Text for an Estimate Customer/Business Name: Mathew Addington Date: 5/11/2023 58 Links Rd Assembly Service Address: Blanchard, ID 83804 Location of Assembly: Type of Hazard Controlled: f=-T Assembly info-Make: h�ll� ��� Serial#G l�d 368 RPBA RPDA DCVA DCDA QN J SVB Size(In): Line Pressure(PSI):/Qd Installation: Horizontal: Y VerticalavD Other' New N Replaces Serial #: Check%'alve 111 Check Valve#2 ReW Valve PVB/SVB soul Of Valves Initial ❑ Held at PSID ❑ Held at PSID ❑ Opened at Opened at Test ❑ Closed Tight ❑ Closed Tight PSID PSID Closed Tight ❑ Leaked ❑ Leaked ❑ Opened Fully Opefied Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ I f� Check held at .D PSID L..1�'�icOQ ❑ CLEANED ❑ CLEANED ❑ CLEANED 'CLEANED CLEANED ❑ ❑ ❑ REPLACED ❑ WLACED: ❑ REPLACED: ❑ RR ED: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ / [3 Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring V, F] Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring C Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Rings) A ❑ Module ❑ Module ❑ Module ❑ Guide 96 - O --- 1 0 ❑ ROM. Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air Net PSID Shut Off Valves #1 #2 Teat PSID PSID PSID I CK Valve ID Closed Tight NOTE.Purveyor mug be notified within 24 bra of any backflow prevention assembly left to a faUed(son-passing)condition. Tester's Name(please print):HAYDEN TANNER ID BAT License#:23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By. B.A.T.SUPPLY Calibration Date:09/24/22 1 cer*the assembly was tested in acordance with U.S.C.ten protocol and was in working condition. Tekt Resulty Passed *cr-- Failcd ❑ Assembivas Left: Weer Service Rawn6j;L BAT TAX Atiaobe`215-� ��psiure of?Ater / �� Copv of Report iw Custonlc!'O vner ❑ Water Purveyor ❑ Licamed Tartar ❑ Water Purveyor: 4J�— Customer/Business Name: Mathew Addin-ton Date: 5f9/2024 58 Links Rd - - Assembly Service Address: Blanchard, ID 83804 Location of Assembly: Right side Type of Hazard Controlled: J-- r JZ Assembly info-Make: G J f/` , 5 7� Serial#�,/t}-fay�p 36 S RPBA RPDA DCVA DCDA OV SVB Sue(In): Line Pressure(PSI): 11 Installation: Horizontal: a N Vertical:VU VD Other: New: Y Replaces Serial #: Check Valve Ml Check Ve1ve02 Rtelief Valve - PVWSVB— T Shut Off Valves «t MZ Initial ❑ Held at PSID Held at TJ_PSID 1 ❑ Opened at eopenod at t Test [] Closed Tight ❑ Closed Tight PSID PSID Closed Tight I j ❑ Lcakcd [j Leaked Opened Fully Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ El 'Ctxc ckhk held at PSID 0 Law (] 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-Ring(s) ❑ O-Rings) C Module ❑ Module ❑ Module ❑ Guide 9 ❑ ❑ ❑ ❑ NOTES: Final ❑ Closed Tight , ❑ CtosedTight ❑ Opened At Air Inlel � SID7 Shut Off Valves 41 092 Test PSID PSID PSID CK Valve PSID Closed Tight NOTE:Purveyor must be notified within 24 Ara of any backflow prevention assembly left In a Palled(non-passtnq)condition. Tester's Name(please print): DAN ROSE ID BAT License#:23366 Company Name: SPRINKLERS NORTHWEST Expiration Date:4/20/2025 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK5 Serial#:02AC22040141 Calibrated By: MAKO Calibration Date:09/21/2023 I terrify the avvernbly was tested in scordance with U,S.C.test protocol and was to working condition Tes' a Us: Vacsed Failcd ❑ Assembly at l.efl: wsta Service�Resamd[�/�—BAT 7aq Attached Co"OrRrtwrtt- CustomerlOwner ❑ watcrPurveyor ❑ Licensed Tester Water Purveyor: Stoneridge Water r ..-- File Purve)r am�{{ or: V I D 11 C t 12 ► C( C� C l)fi I 1 L s No: Senrice Address of assembh' -1 0 I i n K S Location of assemb(r on premise T a(,K 01 h D U S-(- Sum,to:_jpn n KI w Owner of assemble: Owner address: -]o I► n KS Cio,�I an 0 Q" ZIP 92' Q)0`f Manufacturer: 1N 11 K I nS Model No: (_Size I Serial C B13 U3 U 5 Style: RP O DC O DCDA O RPDA O PVB g SVB O Orientation New System Pressure Installation? Reduced Pressure Principle Assembly at rrs location y � PSI Double Check Valve Assembly Check I'alve# l Check l alve#2 Relief 1'alve PUB/SVB INITIAL Held tit PSID Held at PSID Air inlet TEST Opened at PSID opened at Z7 Closed tight O Closed tight O Did not open O Opened Fully�] Leaked O Leaked D Did not open O Check valve Cleaned O Cleaned O Cleaned O held at 2­ L 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 1'atve Continents: Initial test by: C h f is N ct( h Date: 10_ 2 D Certific•ation/License# WI� 3 LLI) Pass10 Fail O Repaired/Cleaned by Date: Final Test by: Date: Certification/Lic•ense# Pass O Fail O Water service restored7YN BAT Form sample t K' 70 Lin kks BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME n . G r^Ifp (,;)q SERVICE ADDRESS Z L r ., 17. l _r i LOCATION OF ASSEMBLY SUPPLY TYPE OF ASSEMBLY { , NEW INSTALL PSI C L ! � MANUFACTURER ,, % I MODEL �'! C; 17 SERIAL 7 SIZE / PVB/SVB. CHECK VALVE#1 CHECK VALVE#2 REUEF VALVE AIR INLET OPENED AT PSID INITIAL TEST OPENED AT PSID HELD AT PSID HELD AT PSID OPENED FULLY A CLOSED TIGHT CLOSED TIGHT Li DID NOT OPEN DID NOT OPEN ❑ LEAKED a LEAKED ❑ CHECK VALVE HELD AT i, 41 LEAKED c CLEAND c CLEAND CLEAND CLEAND REPLACED a REPLACED u REPLACED REPLACED REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT PSID AIR INLET OPENED AT L PSID CLOSED TIGHT CLOSED TIGHT t DID NOT OPEN ❑ CHECK VALVE HELD AT LEAKED r LEAKED n PASS FAIL NOTES GAUGE k MAKE AND MODEL i , t CALIBRATION DA►E TESTER ` , __, LICENSE �,( ( DATE / i P REPAIRED BY DATE FINAI TEST RY LICENSE DATE. WATER PURVEYOR Nash & Son RPM Rr--AI T()" • i Anln'�.CAPiN(-. - F Wt-AVAIICIN a r� 208.500.9747 Call or Text for an Estimate Water _ { I Purveyor. ., 1 (. 1) `� 1(1�1 � l 11) Service Address of assembly Location of assenik on premise Supply to: �.�'p i i n K Le y) Owner of assemble: Owner address: (/� ���1 cyly V I o ah(" Z,rIT_EJJ_0f Manufacturer: L✓g lZ Model No: r�2.4� Sfte 2&SmW ?!V U V Z� - Style: RP O DC 17 DCDA O RPDA O PVB4 SVB O Orientation l� , Reduced Pressure Principle Assembly at tem this oc�on Y l-/ ?� PSI Double Check Valve Assembly Check Valve#I Check Valve#2 Relief Valve PVB/SVB VVITUL Held�?SID Held at�PSID Air inlet/, TEST Opened at PSID opened at 1 Closed tight O Closed tight O Did not open C 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 O FINAL Closed right Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not o n O Check Vain Comments. Initial test by: �I f�1 Date: 2 Cerrification/License f l-tT 2 U)4 Y_ Pass Ef Fail L7 Repaired/Cleaned by Date: Final Test by: Date: Certification/License# Pass O Fail O Water service restored Y N BAT F--V6 LW g-7 L;�k5 BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS LOCATION OF ASSEMBLY ------------ SUPPLY / r i TYPE OF ASSEMBLY NEW INSTALL PSI MANUFACTURER rf MODEL. ti� r� �� C� T SERIAL �( - SIZE / PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT 3 -�!PSID HELD AT PSID HELD AT PSID OPENED FULLY 0, INITIAL TEST CLOSED TIGHT a CLOSED TIGHT OPENED AT PSID DID NOT OPEN o LEAKED n LEAKED DID NOT OPEN �� CHECK VALVE HELD AT LEAKED o CLEAND n CLEAND CLEAND c CLEAND n REPLACED ❑ REPLACED a REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED n CLOSED TIGHT _i CLOSED TIGHT � OPENED AT PSID AIR INLET OPENED AT PSID LEAKED n LEAKED DID NOT OPEN CHECK VALVE HELD AT PASS FAIL NOTES GAUGE# U •S G C Gj MAKE AND MODEL v j L 7' % CALIBRATION DATE TESTER 1 ��_� LICENSE DATE L REPAIRED BY DATE FINAL TEST BY LICENSF DATE WATER PURVEYOR Nash & Son RPM RFAI-TOR •LAN1>SCAPIN(.• F wrAVATIhNI 1208.500.9747 Call or Text for an Estimate Customer/Business Name: Ted Hill Date: 5/11/2023 131 Links Rd Assembly Service Address: Blanchard, Ill 83804 Location of Assembly: front bed Type of Hazard Controlled. Assembly info-Make: WILKINS MODEL: 720A Serial# T399733 RPBA RPDA DCVA DCDA%P H S%B Size(In): Line Pressure(PSI):1-et' Installation: Horizontal: Y V1) Other: New: Y f�- Replaces Serial #: __Check valve Kl Cheek Valve#2 Relief Valve PVMVB Sbat off valves 1 #I #2 initial I ❑ Held at PSID ❑ Held at PSID ❑ Opened at Opened at Test closed Tighi Closed Tight PSID 4_ PSID I Closed Tight [� Leaked ❑ Leaked ❑ Opened Fully I Q Opened Fully Did Not Open ❑ Did Not Open Leake 1-3 El d Check h_e_ld at (-r�ID -- I ❑ Leaked i ❑ CLEANED CLEANED I ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ [] REPLACED: ❑ UPLACED; ❑ REPLACED; ❑ i PLQ p, ❑ Disc ❑ Disc ❑ Disc i ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring Spring Spring ❑ Air Inlet Spring i ❑ Guide Guide Guide ❑ Check Disc pp,r11 ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring e I ❑ Hinge Pin Hinge Pin I ❑ O-Ring(s) ❑ O-Ring(s) ❑ Module ❑ Module ❑ Module I ❑ Guide d W ❑ o - i ❑ --- i- ❑-- - --- — oe NOTES: -- - - -- Final ❑ Closed Tight ❑ Closed Tight ^❑ Opened At T Air Inlet��PSID Shtrt Off Valves #1 #2 Teat PSID PSID PSID j CK Valve /. PSID I Closed Tight NOTE:Purveyor most be notified within 24 brs of any backflow•prevention assembly left in a failed(non-Dassine)condition. Tester's Name(please print): HAYDEN TANNER ID BAT License#: 23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By: B.A.T. SUPPLY Calibration Date: 09/24/22 I certify the anernbly was tested in acordence with U.S.C.test protocol and was in working condition, Test Restdts: Passed Failed ❑ Anembly ss Left: Water Service Restored& BAT Tay,Attach Sigarruue of Triter L Date Copy of Report to: Customer/Owner ❑ W 7W,,p.,V,eyol ❑ Licensed Teeter ❑ Water Purveyor: STONERIDGE CustomerBusinessName: Ted Ilill Date 5/9/2024 131 Links Rd -- - - Assembly Service Address: Blanchard, I D 83804 Location of Assembly: front bed Type of Hazard Controlled: R r\ Assembly info-Make: WILKINS MODEL: 720A Serial# T399733 A• RPBA RPDA DCVA DCD:4 SVB Size(in): Line Pressure(PSI): _ Installation:Horizontal: '© N Vertical:VU VD Other, New: Y Replaccs Serial #: f check valve#] c_eeek Valve#2 Relief Valve PVB/SVB Shut Off Valves lnitial ❑ Held at PSID ❑ Held at PSID ❑ Opened at [ll�penod at ri l I- � Test ❑ Closed Tigbt ❑ Closed Tight PSID PSID Closed Tight �.- ❑ Leaked ❑ Leaked ❑ Opened Fully Opened Fully ❑ Did Not Open ❑ Did Not Open Lcakcd ❑ ❑ heck held at 2.Q PSID _ ❑ Leaked ❑ (..LEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ REPLACED; ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED I ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Intel Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ Seat ❑ Scat ❑ Scat ❑ Check Sprung G ❑ Hinge Pin ❑ Hinge Pm ❑ O-Ring(s) ❑ O-Rings) IX ❑ Module ❑ Module ❑ Module ❑ Guide El a� NOTES: I Final Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet PSID Shut Off Vatves #l #2 Test PSID PSID l PSID CK valve 'r PSID Closed Tight �� L NOTE:Purveyor must be notMed within 24 hra of any backilow prevention assembly left in a failed(non-passln¢)condition. Tester's Name(please print):DAN ROSE ID BAT License# :23366 Company Name: SPRINKLERS NORTHWEST Expiration Date:4/20/2025 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK5 Serial#:02AC22040141 Calibrated lay: MAKO Calibration Datc:09/21/2023 I certify the sacnnhly was tested in wordance with U.S.C.test proocol and was to workinS conditiria. au)u: Passed Failed ❑ AnemblY es Left: Watat Service RWmed2—BAT Tag Arwched2-- -- !0>—/,/7 1,2f Sic ef'rsnrr Dats Capv of ReVart to: Cusrome00-- ❑ Weser i'un�ynr Liceaaed Tester L!� Water Purveyor; STONERIDGE Customer/Business Name: 134 Links Rd gate:4-27-2023 Assembly Service Address: 134 Links Rd Location of Assembly: right side of house Type of Hazard Controlled:Sprinkler System Assembly into-Make:FebCo Mudd y.850U Scnal ,,:H14286 icvvi o RPBA❑RPDA O D('VA ID D(-DAOPN'BOS'*'B❑ Sizc 0n):1 Line Pressure(PSI): 100 Installation:Horizontal: O) ❑N Vertical: \U V D Other (circle) New: ❑Y I7\ Replaces Serial#: Check Vale#I ('heck%aise#2 Relief Valve PVWSVB Shut Off Valves I Initial 0 Held at 2 2 PSID ❑✓ Held a1 2 7 PSIO ❑ Opened at \ir Inlet opened at Test ❑ Closed Tight ❑ Closed Tight PSID PSID Closed Tight Q Q ❑ Leaked ❑ Leaked ❑ Opened Fully ❑ ()pcnedFWly ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ ❑ Check held at PSID ❑ Leaked ❑ CLFANED D ('LEANED ❑ CI.FANF.D ❑ ('LEANED CLFANED ❑ ❑ ❑ REPLACED: ❑ RF.PLAC'ED: ❑ REPLACED: REPLACED: ❑ Disc ❑ Disc ❑ Disc ❑ r„ppet i Final REPLACED ❑ ❑ ❑ Spring D Spring ❑ Spring Air Inlet Spring p Guide ❑ Guide ❑ Guide ❑ Chuck Disc ❑ Scat ❑ sett ❑ Scat ❑ Check Spring ❑ Hinge Pin ❑ Binge Pin ❑ O-Rings) ❑ O-Ring(s) ❑ Module ❑ Module D Module ❑ Guide ❑ ❑ D ❑ z NOTES: Final ❑ Closed Tight ❑ Closeli Tight ❑ t)limed \t ❑ ,. PSID Shut OIL Valves #1 #2 Pest 2-2 PSID 2.7 PSit) 11SID f\ \.ih. PIS D Closed Tight ❑r Q NOTE: Purveyor must be notified Nsithin 24 hrs of any baclfloit pre,�entinn assernbly left in a failed(non-passing)condition. Tester's Name(please print): Joseph Dane Wolfe ID BAT License#: 16116 Company Name: Hard To Scape Expiration Date: 5-10-24 Company Phone: 208-755-4830 Fax#: Test Equipment Make&Model: Midwest 845 Serial#: 05172495 Calibrated By. BAT Calibration Date:3-11-2023 1 certify the asscrnbly was tested in acordance with U.S.C.test protocol and was in working condition Test Results: Passed ❑Q Failed ❑ Assembly as Left: Service Restored ❑ 13AT Tak Attached Q 4-27-2023 SiS'mturc ul'-resrcr 0 UUarc Copy of Report to: Customer Owner Q Water Purveyor ✓❑ Licensed Testcr ✓❑ Water Purveyor: City of Rathdrum 0 Norrh ldaho R gi..n:d W'aier P.uvcyora tlacWo-A+.cmbly Tat R Ixxt N(R WP 0-AM. (1S Customer/Business Name:Dale Nosworthy Date:5-9-2024 Assembly Service Address: 134 Links Location of Assembly: Right Side of house Type of Hazard Controlled:Sprinkler system Assembly into-Make:Febco Model#:850U Serial#:H14286 (circlol RPB:►❑RPDA❑DCVA❑DCDA❑PVB❑SN'B❑ Size(In):1 Line Pressure(PSI): 100 Installation:Horizontal: 0Y ON Vertical. VU VD Other: Laski New: 0 Y 0 N Replaces Serial a: Check Valve Ott Check Valve#2 Rclief%'al%e P%'B/SVB Shut Off'*'gives sl tt? Initial Q Held at 2.0 PSID ElHcld at 2.6 PSID ❑ Opened at ❑ Air Inlet opened at Iest ❑ Closed Tight ❑ Closed Tight PSID PSID Closed Tight Q ❑r ❑ Leaked ❑ Leaked ❑ C)pened Fully ❑ Opened Fully Did Not Open ❑ Did Not Open Leaked ❑ ❑ ❑ Check held at PSID ❑ Leaked ❑ CLEANED D CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: D RLPLACED: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ Spring D Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide D Check Disc ❑ Seat ❑ Seat D Seat ❑ Check Spring Hinge Pin ❑ Itinge Pin ❑ O-Rings) ❑ O-Ring(s) a ❑ Module ❑ Module D Module ❑ Guide ❑ ❑ D ❑ NOTES: Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet PSID Shut Off Valves a 1 n2 Test 2.0 PSID 2.6 PSID PSID CK Valve PSID Closed Tight Q Q NOTE:Purveyor must be notified within 24 hrs of any backilow prevention assembly left in a failed(non-passing)condition. Tester's Name(please print): Joseph Dane Wolfe ID BAT License�: 16116 Company Name: Roots Landscape Co. Expiration Date: 5-10-25 Company Phone: 208-755-4830 Fax#: Test Equipment Make&Model: Midwest 845 Serial#: 05172495 Calibrated By: BAT Calibration Date:3-06-2024 1 certify the assembly was tested in acordance with U.S.(' test protocol and was in working condition Test Results: Passed Q Failed ❑ Assembly as Left: Service Restored ❑ BAT Tag Attached ✓❑ 5-9-2024 Signature of Tester Date Copy of Report to, Customer/Owner 0 Water Purveyor Q Licensed Tester ✓❑ Water Purveyor: Hayden Irrigation Q North Idaho Regional w'atcr Pun eyun Backflow•Assembly Tect Report NIR%?0-AM, GS �o�,.�.,�x-oo b Customer/Business Name: Barbara Blanchard Date: 6/1/2023 14.3 Links Rd Assembly Service Address: Blanchard, ID 83804 Location of Assembly: R SIDE Type of Hazard Controlled: /f 1/l;�t/ Assembly info-Make: tli�JL�'1 A; S 7 Serial# RPBA RPDA DCVA DCDA/ItY6 SVB Size(In): Line Pressure(PSI):Lle Installation:Horizontal: Y Vertical;/ VD Other: New: Y a Replaces Serial # Cheek Valve 01 Check Valve#2 Relief Valve PVWSVB Sbot Off Valves #1 #2 Initial ❑ Held at PSID ❑ Held at PSID ❑ opened at Opened at Teat ❑ Closed Tight [ Closed Tight PSID LZPSiD Closed Tight ❑ Leaked [ Leaked ❑ Opened Fully Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ Check held at �` r PSID ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ REM&= ❑ IMPLACED, ❑ REPLACED: ❑ RMACED: i ❑ Dise ❑ Disc Ej Disc ❑ Poppet/Float REPLACED r] ❑ ❑ $1* ❑ Spring ❑ Spring ❑ Au Inlet Spring ❑ Guide ❑ Guide Guide ❑ Check Disc Wr ❑ Seat ❑ Seat I E] Seat ❑ Check Spring C ❑ Hinge Pin [] Hinge Pin ❑ O-Rings) ❑ O-Ring(s) ❑ Module ❑ Module 0 Module ❑ Guide NOTES: I Final ❑ Closed Tight j ❑ Closed Tight ❑ Opened At Air inlet PSID Shut Off Valves #1 #2 Test PSID PSID PSID CK Valve Z,�f _PSID Closed Tight ` _ t NOTE:Purveyor most be notified within 24 bre of any backflow prevention assembly left in a failed(non-passim)condition. Tester's Name(please print):HAYDEN TANNER ID BAT License#:23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Teat Equipment Malts&Model: MIDWEST$45 ScrW#:03141084 Calibrated By: B.A.T.SUPPLY Calibration Date:09/24/22 I certify the assembly was tented in scordancc with U.S.C.test protocol and was in working oondition. Test Results: Passed I. Faded ❑ Assembly as Left: Water Service RestotsalNL BA I t:,x noaehaNl— C'ov%of Revert to: Custerocr/Owner ❑ Water Purveyor ❑ Lioeased Tester ❑ Water Purveyor: ly3 Links BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS / I OCATION OF ASSEMBLY 1- SUPPLY Ttr TYPE OF ASSEMBLY 1 , NEW INSTALI P i MANUFACTURER �. � MODEL > SERIAL PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT l I -i INITIAL TEST OPENED AT PSIf' HELD AT PSID HELD AT PSID OPENED FULLY CLOSED TIGHT CLOSED TIGHT a DID NOT OPEN L, DID NOT OPEN LEAKED LEAKED CHECK VALVE HELD AT - LEAKED r: CLEAND CLEAND CLEAND CLEAND REPLACED REPLACED REPLACED a REPLACED r.. REPAIR/FINAL HELD AT PSID HELD AT PSID OPENED AT PSID AIR INLET OPENED AT PSIF) CLOSED TIGHT CLOSED TIGHT DID NOT OPEN CHECK VALVE HELD AT LEAKED c LEAKED PASS FAIT_ GAUGE k MAKE AND MODEL CALIBRAI ION DATE TESTER LICENSE ) DATE REPAIRED BY DATE FINAL.TEST BY LICENSE DATE. WATER PURVEYOR ��•IC �� Nash & Son RPM RFAI TOR -I ANDICAPINC..• EXCAVATION A 208.500.9747 Call or Text for are Estimate J Customer/Business Name: Bob Hoepfer Date: 6/14/2023 Assembly Service Address: 163 Links Road, Blanchard Location ot'Assernbly: Left side of horde ry peoftlacardControned: Lawn Sprinklers Assembly info-Make: Watt model s: 775 QT s«ial#: 43209 (cttclri RPBA RPDA D('V DCDA PV'B SVB Size In 11n ( ) Line Pressure(PSI): Installation IloriTontal: Y N VcTtical: VU VD Chhec (cuclo) New Y V Rt-places Serial# Chrrk yaFae Fl Check Valve 002 Relief valve PVBCSVB Shut Off V■Ivh #I n' Initial rleld at/.—?- PSID 1% Held at 2 -0 PSID ❑ opened at ❑ Air Inlet opened at Fest Closed Tight 4 Closed Fight PSID PSID Closed Tight ❑ Leaked ❑ Lcakcd ❑ Opened Fully ❑ Opened Fully ❑ Did Not Open ❑ Did Not Open I-caked ❑ ❑ ❑ Check held at PSID ❑ Leaked ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLFANED CLEANED ❑ ❑ I ❑ BEPI ACED ❑ REPLACED ❑ REPI.ACt;.D ❑ RLPtz9CL-1) ❑ Disc ❑ Disc ❑ Dlse ❑ Poppct/Float REPI.ACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring Guide ❑ Guide ❑ Guide ❑ Check Disc ❑ seat ❑ `eat ❑ Seat ❑ Check Spnng < ❑ ICtnge Pin ❑ Hinge Pm ❑ O-Ring(s) ❑ O-Rings) gg ❑ Module ❑ Module ❑ Module ❑ Guide ❑ ❑ ❑ ❑ Cie NOTES: Fatal ( Closui Tight Close Tight ❑ Opctitrd At Air inlet PSID Shut Ott Valves #1 #? Lest _PSID -VPSlD PSIU C'KValve PSID Closed Iight NOTE:Purveyor must be notified within 24 hrs of any back0ow prevention assembly left in a failed(non-passing)cundit on. Tester's Narne(please print): Ed Horn ID BAT License#: 2386 1 ,___ company Name: Advanced Sprinklers L'xpiration�/612024 company Phone: 208-687-1955 Fax#: 208-687-2625 Test Equipment Mahe&Model: Midwest 845 Serial#. 11071676 C'allbrated Bv: BAT Calibration Date. 3/11/2023 1 centtN the assembly was tested in acordance with U.S.C.tCst protocol and w&s in working condition esults: Pawed . raw ❑ Amcmbly as Left: Service Restored BAT Tag Attached �et I)Ate Copy of Reporl to: Customer(Owri tVl Water Purveyor Licensed nester Water rurvcv,ol. _ Stoneridge N.rth l"u,Reip-mat W.I.Aava)ors Oackflow Assembly Test Rerx,rr NIRUTO-AM. GS Cttstomer/Business Name: Bob Hoepfer Date: 5/30/2024 Assembly Service Address: 163 Links Road, Blanchard LocWionofAssembly Left side of home Typcof Hazard Controlled: Lawn Sprinklers Assembly info-Mnke: Watts Model#: 775 QT Serial#: 43209 (code) RPBA RPDA 6NA DCDA PN•B S`'B Sue(In): tin Line Pressure(PSI): �/U Inslallntion:horizontal: � N Venial. VU VD Other: tcndet New: Y Iteplaees SeTIHI p. Check Valve Ml Check Valve 02 Relief Valve PVR/SVR Shut Off Val." � / MI a^_ Initial Held at—1.�--Ll.�PSID Held at It 6 PSID ❑Opened at ❑ Air Intel opened at Test b-Closcd'Iight O Closed-right PSID PSID Ciosed Tight ❑ Iealixd ❑ Leaked ❑opened rung ❑Opened Fully ❑ Did Not Open ❑ Did Not open Leaked ❑ ❑ ❑ Check held at PSID ❑ Leakod ❑CLEANED ❑CLEANVA) ❑CLEANED ❑CLiiANF) Cl IANED ❑ ❑ ❑ gtPLACED ❑ REPLACED ❑ RF'PI.ACGD ❑ REPLACED. ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/{•'lost RG.PI_ACF.D ❑ ❑ ❑ Spring ❑ spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑Guide ❑ Chock Disc ;� ❑ seat ❑ seat ❑ sea, ❑Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑O•Ring(s) ❑ 0-Ring(s) Y ❑ Module ❑ Module ❑ Module ❑Guide ❑ ❑ ❑ ❑ `z NOTES: Final Closed'fight Closed light ❑ Opcnod At Air Inlet I'Sll) Shut,)IT Valves r I _ a2 Test It IL PSID L I'SID PSID CK Valve PSID C'Insed 1 ight C'I/ NOTE:Purveyor must be notified within 24 hrs of any baekilow prevention assembly left In a failed(non-nassinit)condition. TestcesNume(please print): Josh Mitchell IDBATUcense#: 19350 Company Name: Advanced Sprinklers Expiration Dote: 1/1 0/2025 Company Phone: 208-687-1955 _ Fax#: 208-687-2625 Test Equipment Makc&Model: Midwest 845 Serial#: 01120969 calibrated By: BAT (calibration Date: 3/6/2024 I certify the assen,bi was tested in sconiance with U.S.C.test protocol and was in working condui ; T�s esulIs; Passed Holed ❑ Attaembly as Left: Service Restorod BAT Tait Attac:hcd tote y of Report to: Customer/owne Water Purveyor Licensed Tester Water Purveyor Stoneridge Nunh tdahn Rogiunal Wato Purveyors Backnav AssemNy Ten Repun NIRWIb AM.GS Customer/Business Name: Ted Dill Date: 5/11/2023 178 Links Rd Assembly Service Address: Blanchard, ID 83804 Location of Assembly: Type of Hazard Controlled: Assembly info - Make: IJ! I ' .,i Serial#ILI � z RPBA RPDA DCVA DCDA 0 SVB Size(in): Line Pressure(PSI): Installation: Horizontal: Y (� Vertical:Qi VD Other New: Y N Replaces Serial #: Cheek Valve#1 Cheek Valve#2 Retief Valve PVB/M Ihttt Off, Valvp 11nitial ❑ Held at PSID ❑ Held at PSID ❑ Opened at Opened at #1 02 Test ❑ Closed Tight [] Closed Tight PSID -5_L PSID Closed Tight ❑ Leaked ❑ Leaked ❑ Opened Frilly N Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ Check held at Z'iL PSID ❑ Leaked — ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ R-EPLACED: ❑ REEL.ACpp: ❑ REPLACED: I ❑ REPLACEP: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet I Float REPLACED ❑ ❑ - ❑ Spring ❑ Spring ❑ Spring I ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc W ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring A ❑ Hinge Pin [] Hinge Pin ❑ O-Ring(s) ❑ O-Ring(s) 04 ❑ Module ❑ Module ❑ Module ❑ Guide ❑ -- ❑ - �❑----- ❑ NOTES: — Matti] ❑ Closed Tight ❑T Closed Tighl ❑ Opened At Air inlet 3,1—PSID Shut Off Valves ill a2 Teat PSID PSID PSID CK Valve 49' PSID Closed Tight NOTE:Purveyor must be notified within 24 hrs of ony backflow prevention assembly left in a failed(non-passing)condition. Tester's Name(please print):HAYDEN TANNER ID BAT License# : 23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial 0:03141084 Calibrated By: B.A.T. SUPPLY Calibration Date:09/24/22 1 certify the mAemltty was tested in acordance with U.S.C.twt protocol and was in working condition. _ Tat Results: Passed AE3., Failed ❑ Assembly as LAM Water Service Resin-is, BAT Tag AttachQ&" <,,p�of Rruort to: Custom +weer Water Purveyor ❑ Licensed Tester ❑ � r Water Purveyor: ,�- Customer/Business Name: Ted hill Date: 5/9/2024 178 Links Rd Assembly Service Address: Blanchard, ID 83804 Location of Assembly: Right side Type of Hazard Controlled: Assembly info-Make: Wilkins/720A Serial# EAA66433 RPBA RPDA DCVA DCDA OV SVB Size(In): Line Pressure(PSI): 78 Installation: Horizontal: /0 N Vertical: VU VD Other: New: Y Replaces Serial #: Finitial Check Valve#1 Check Valve#2 ReberValve PVB/SVB Shut O[I Valves#1 #2 ❑ Held at PSID ❑ Held at PSID ❑ opened at dOpened at Test ❑ Closed Tight ❑ Closed Tight PSID I 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 f CLEANED ❑ ❑ ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ REPLACED: ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Cheek Disc ❑ Seat ❑ seat ❑ seat ❑ Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑ O-Ring(s) ❑ O-Rings) ❑ Modulo ❑ Module ❑ Module ❑ Guide ❑ ❑ ❑ ❑ NOTES: — Final ❑ Closet!Tight ❑ Closed Tight ❑ Opened At Air Inlet 3• j PSID Shut Off Valves #1 #2 Test PSID PSID PSID CK Valve PSID Closed Tight NOTE:Purveyor must be notified within 24 hrs of any backflow prevention assembly left in a failed(non-passintt)condition. Tester's Name(please print): DAN ROSE ID BAT License# :23366 Company Name: SPRINKLERS NORTHWEST Expiration Date:4/20/2025 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK5 Serial#:02AC22040141 Calibrated By: MAKO Calibration Date.09/21/2023 1 cenify the assembly was tested in aeonlance with U.S.C.teat protocol and was to working condition. T Re Its- Passed , � Failed [--IAssembly as Lett: Water Service Rcstvmd�BAT Taft Anachadl� C_ a-- 5iaa.,,a of ens � Coov of Report to: Cusion erlOwner ❑ water Purveyor ❑ Licensed Teats Water Purveyor: Stoneridge 6 Customer/Business Name: Richard Lewis Date: 5/11/2023 33 Parkland Dr Assembly Service Address: Blanchard, ID 83804 Location of Assembly: R side Type of Hazard Controlled: Assembly info- Make: Serial# "' �¢ RPBA RPDA DCVA DCDA PV SVB Size(in): Line Pressure(PSI): 9 Installation: Horizontal: Y 01 ' Vertical J�J ,VD Other: New: Y !\ (% Replaces Serial # Check Valve#1 Chock Valve 02 Retlef Valve I PVB/M Shat oa Valve Initial [] Held at PSID ❑ Held at PSID ❑ Opened at Opened at #1 #2 Test ❑ Closed Tight ❑ Cioaed Tight PSID 'JL PSID Closed Tight ❑ Lamed ❑.L"ked ❑ Opened Fully I Opened Fully ❑ Did Not Open ❑IDid Not Open Learned ❑ ❑ CSLCteck held at PSID ❑ Leaked ❑ CLEANED — ❑ CLEANED (] CLEANED ❑ CLEANED CLEANED ❑ ❑ ❑ K-U-PLACbP: ❑ U.PJ&CED: ❑ REPLACED: ❑ REPLACED.- ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide I ❑ Cheek Disc ❑ Seat ❑ Seat ❑ Seat ❑ Check Spring O ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Rings) ❑ Module ❑ Module ❑ Module ❑ Guide a ❑— -- ❑ -- ❑-- ❑— OC NOTES: ----- — - _ Of Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Au WNW PSID 17Shlut�OfffValves #1 N2 PSID PSID PSID CK Valve:PSID sed Tight NOTE:Purveyor mutt be notified within 24 bra of any backilow prevention assembly left In a failed(non-passine)condition. Testees Name(please print):HAYDEN TANNER ID BAT License#: 23903 Company Name: SPRINKLERS NORTHWEST Expiration Date:05/01/24 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By: B.A.T. SUPPLY Calibration Date:09/24/22 1 certify the asserebly was tested in scordaoce with U.S.C.test protocol and was in working condition. Test Results. Passed L�SI Failed ❑ Assembly as Left: Watt Service Re6t red . BAT Tex Ab-b-olts, 3ign.nm of Tn� rhu Copv of Report to: Custommiownet ❑ Warm Purveyot ❑ Llceand Tester ❑ Water Purveyor- Customer/Business Name: Richard Lewis Date: 5/9/2024 33 Parkland Dr Assembly Service Address: Blanchard, ID 83804 Location of Assembly: R side Type of Hazard Controlled: Assembly info-Make: ��,� Serial# RPBA RPDA DCVA DCDA cpv'B' :VB Size(In): Line Pressure(PSI): ?)b Installation: Horizontal: Y N Vertical:VU VD Other: New: Y e) Replaces Serial At: Check Valve#1 Check Valve#2 Relief Valve PVBISVB Shot Off Valves #1 #2 Initlai ❑ Held at PSID ❑ Held at PSID ❑ Opened et 16 Opcaed at ® �0 Test ❑ Closed Tight (] Closed Tight PSID � •2-PSID Closed Tight ❑ Leaked ❑ Leaked ❑ Opened Fully 0 Opened Fully ❑ Did Not Open ❑ Did Not Open Leaked ❑ ❑ m Check held at 1--1 PSID .._-- ❑ Leaked I ❑ CLEANED ❑ CLEANED ❑ CLEANED ❑ CLEANED - CLEANED 111 ❑--- ❑ ❑ REPLACED: ❑ REPLACED ❑ REPLACED: ❑ REPLACED: ❑ Dix ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc �.t ❑ Scat ❑ Seat ❑ Seat ❑ Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(s) Q ❑ Module ❑ Module ❑ Module ❑ Guide o�C NOTES: Final ❑ Closed Tight ❑ Closed Tight ❑ Opened At Air Inlet {. PSID Shut Off Valves 01 #2 Test PSID PSID PSID CK Valve 2• PSID Closed Tight Z Zr NOTE, Purveyor must be notified within U brs of any ba-&flow prevention assembly left in a failed(non-paaaiatt)condition. Testers Name(please print): NICK NEVAREZ ID BAT License#:BAT- 26182 Company Name: SPRINKLERS NORTHWEST Expiration Date:2/21/25 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK-5 Serial#:02AC22040142 Calibrated By: MAKO Calibration Datc 9/21/2023 I certify the sssanbly was tesiod in aeordanee with U S.C.test protocol and was in working condition Test Results: Passed m Failed ❑ Assembly os Lett: Water Setviec RestoreJ(n BAT Tap Anachcdm Sipuoue of Teser — — IHtr Coov of Report to: Customer/Owner ❑ atu Purveyor ElUceosed Tester Q Water Purveyor: nert� � Water ( I File Purveyor: No: .Service Address of assembly. Ly Location of assembly on premise 1"�— Supply to: D rl n K I a s Owner of assembly: Owner address: � pn.r I n�I �fi City I� jil ZIP Q� Manufacturer: L/t ,Gl,ram�, - MOM No. 1__�> (=ySize_ _Strial� Style: RP O DC DCDA O RPDA O PVB O SVB O Orientation New Fthis ssure Installgt, ? Reduced Pressure Principle Assembly tion Y N PSI Double Check Valve Assembly Check Valve# 1 Check Valve#? Relief Valve PVB/SVB INITIAL Ileld at 2-yPSID Held at--2, ( _PSID Air inlet _j TEST Closed Opened at PSID opened at tight� Closed tight Did not open O Opened Fully O Leaked O Leaked O Did not open a 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 L7 Leaked O Did not open O Check Valve Comments: Initial test by: Chris N Q S h Date: :9 , d 23 Certiftcation/License# � 2 L}Uj Pass'p Fail O Repaired/Cleaned by Date: Final Test by: Date: Certific•ation/License# Pass V Fail O Water service restored? N BAT Form s—pk I AV BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME SERVICE ADDRESS 3 P,, r kl, T LOCATION OF ASSEMBLY ru S SUPPLY TYPE OF ASSEMBLY ,) ' NEW INSTALL PSI 3(J MANUFACTURER 1�) �! C� MODEL !? SERIAL A-7' ,2 e*Q, SIZE PVB/SVB CHECK VALVE#1 CHECK V LVE tt 2 RELIEF VALVE AIR INLET OPENED AT PSID r HELD AT �- PSID HELD AT_�PSID OPENED FULLY c INITIAL TEST CLOSED TIGHT n CLOSED TIGHT OPENED AT PSID DID NOT OPEN u LEAKED r LEAKED DID NOT OPEN CHECK VALVE HELD AT LEAKED a CLEAND ❑ CLEAND .. REPLACED ::r REPLACED CLEAND CLEAND REPAIR/FINAL HELD AT PSID HELD AT PSID REPLACED REPLACED u CLOSED TIGHT :.� CLOSED TIGHT a OPENED AT PSID AIR INLET OPENED AT PSID LEAKED r; LEAKED DID NOT OPEN CHECK VALVE HELD AT PASS FAIL N�11F , 6AU0E# L MAKE AND MODEL L i CALIBRATION DAI E �. TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY LI r'J ALICENSE 4: DATE 2 WATER PURVEYOR I Nash & Son RPM REALTOH •LANDSCAPING•F XCAVATION \( v 208.500.9747 Call or Text for an Estimate U� 88 Par Hand CT_ Customer/Business Name: Richard Speidell Date: 5/11/2023 88 Parkland Court Assembly Service Address: Blanchard,Ill 83804 Location of Assembly: Left Side Type of Hazard Controlled: Assembly info-Make: WILKINS/350 Serial# 3145616 a RPBA RPDA DCDA PVB SVB Size(in): Line Pressure(PSI): �0 Installation:Horizontal: N Vertical: VU VD Other: New: Y Replaces Serial #: _ Cheek Valve Nl Check Valve#2 RaW Valve _ PVB.y Shut Off Valves #l K2 Initial Held at 2./J PSID Held at SID El Opened at `❑ Opened at— _ Teat i ,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 ❑ ❑ ❑ REPLACED: ❑ MLACE ❑ RULACUD.: ❑ REPLRCM- ❑ Disc ❑ Disc ❑ Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring ❑ Spring ❑ Spring ❑ Air Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Cheek Disc ❑ seat ❑ Seat ❑ Seat ❑ Check Spring ❑ Hinge Pin ❑ Hinge Pin ❑ O-Rings) ❑ O-Ring(s) G ❑ Module ❑ Module ❑ Module ❑ Guide El NOTES: Final �-Closed Tight ,Closed Tight ❑ Opened At Air Inlet PSID Shut Ofr Valves p 1 82 Test ! PSID 0 PSID PSID CK Valve PSID Closed Tight NOTE:Purveyor must be notified within 24 bra of any,backflow prevention assembly left in a faded(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: 208-818-8838 Email: Test Equipment Make&Model: MIDWEST 845 Serial#:03141084 Calibrated By: B.A.T.SUPPLY Calibration Date:09/24/22 1 certify the assembly waa tared in aeordaneo with U.S.C.taat protocol and was in woddng eoa t on. Teat Results: Passed Failed ❑ Axciubly n Left: wales Service ReatWe1 f!3. BAT Tap Attactied&,.,_ Sia•atuea erTat.r - �' � D•u -- I ' Copv O keport rot Customm.k)wner ❑ Nat"h veyot ❑ Lic-cand TwAt ❑ Water Purveyor: STONERIDGE Customer/Business Name: Richard Speidell Date: 5/9/2024 88 Parkland Court Assembly Service Address: Blanchard, ID 83804 Location of Assembly: Left Side Type of Hazard Controlled: Assembly info-Make: WILKINS/350 Serial# 3145616 RPBA RPDA A F'Af DCDA PVB SVB Size(In): Line Pressure(PSI): �� installation:Horizontal: N Vertical: VU VD Other: New: Y Replaces Serial # Check Valve#1 ^Check Valve 02 ReNef Valve PVBJSV$ _ Shut Off Valves I #2 Initial Held atZ.4l PSID Held at 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 El 0 El Cheek held at PSID ❑ Leaked ❑ CLEANED [] CLEANED [:] CLEANED ❑ CLEANED CLEANED [] ❑ ❑ REPLACKM ❑ REPLACED; (] REPLACED: ❑ REPLACED: ❑ Disc ❑ Disc [] Disc ❑ Poppet/Float REPLACED ❑ ❑ ❑ Spring [] Spring [] Spring ❑ Au Inlet Spring ❑ Guide ❑ Guide ❑ Guide ❑ Check Disc W ❑ Seat EJ Seat ❑ Seat Check Spring A ❑ Hinge Pin Hinge Pot O-Rings) O-Rings) Module ❑ Module ❑ Module Guide ❑ ❑ ❑ ❑ NOTES: Final Clos Tight to Tight [] Opened At Air Inlet PSID Shut Off Valves #1 #2 Test ZAPSID `_L.2 PSID PSID CKValve PSID Closed Tight NOTE:Purveyor must be notified within 24 hrs of any backflow prevention assembly left in a failed(non-passlne)condition. Testers Name(please print):NICK NEVAR-Z ID BAT License#:BAT-26182 Company Name- SPRINKLERS NOR'rHWEST Expiration Date:2R1/25 Company Phone: 208-818-8838 Email: Test Equipment Make&Model: MAKO MK-5 Serial#:02AC22040142 Calibrated By: MAKO Calibration Date 9/21/2023 I cM*the assembly was tested 1n acoMwnce with U.S.C.tat Protocol wad was in working condition Test Rmulta: Passed Failed ❑ Assembiv as Left: water Service Restoredr/I BAST T.K Attached Simuwe Of Ttacr Wte Copy of Retwrt to: Customer/Owner ❑7.ter Purveyor ❑ Livased Tester 7 Water Purveyor STONERIDGE Water F"de Purveyor. n e 1� Q�. U 1 I No: Service Address of assembly Location of assembly on premise &PPly to: (Se n n K i ck Owner of assembly: C O�V I Owner address: 14� 1 i'� � r r tr o c l C& fbArLl ZIP Manufacturer: 1. -� , .Model No: 3 Co .ZS L Size___Seriaf Style: RP O DC)L DCDA O RPDA O PVB O SVB O Orientation New System Pressure InstaUgti"? Reduced Pressure Principle Assembly at this location P �ifZ5, _PSI Doxable Check Valve Assembly Check Valve#l Check Valve#2 Relief Valve PVBISVB INITIAL Held at 2.Z PSID Held at 'L.2—PSID Air inlet TEST Opened at PSID opened at Closed fight� Closed tight Did not open O Opened Fully O Leaked O Leaked O Did not open O Check valve Cleaned D Cleaned O Cleaned O held at REPAIRS Replaced D Replaced O Replaced O Leaked D Cleaned O Replaced O FINAL Closed tight Closed tight Opened at Air infer TEST Leaked O Leaked O Did not open 0 Check Valve Comments: Initial test by: C h r I S N a s h Date: �9-1 d '23 Certifrcatlon/License# B Pass Fail O Repalred/Cleaned by Date: Find Test by: Date: Certifrcatiox4Jcexse# Pass O Fail O Water service restored? N BAT Fu nmpk LW ( L43 1 Imo >r�r BACKFLOW PREVENTION ASSEMBLY TEST REPORT CUSTOMER NAME !' /v L)I SERVICE ADDRESS LOCATION OF ASSEMBLY SUPPLY TYPE OF ASSEMBLY ) NEW INSTALL PSI 5 S MANUFACTURER J 1 ,'^ MODEL j S SERIAL ( Y7 SIZE I PVB/SVB CHECK VALVE k 1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT HELD AT a• I PSID HELDAT�`LPSID OPENED FULLY INITIAL TEST CLOSEDTIGHT 8 CLOSEDTIGHT B OPENED T PSID DID NOT OPEN LEAKED ❑ LEAKED ❑ DID DN NOT OPEN a CHECK VALVE HELD AT LEAKED❑ CLEAND In CLEAND o CLEAND r: CLEAND REPLACED ❑ REPLACED REPAIR/FINAL HELD AT PSID IIF.LDAT PSID REPLACED n REPLACED n CLOSEDTIGHT a CLOSED TIGHT RIPENED AT PSID AIR INLET OPENED AT PSID LEAKED r LEAKED DID NOT OPEN CHECK VALVE HELD AT SPAS$ FAIL GAUGE a i I MAKL AND MODEL C� w ` r ., S�. �, CALIBRATION DAIL TESTER LICENSE DATE REPAIRED BY DATE FINAL TEST BY �n ( UJ LICENSE r DnrF / WATER PURVEYOR S t` �' I C Z ` 1 /` .i r,l Mash & Son RPM •I ANO),CICAVATIC]N w 7' 208.500,9747 Call or Text for an Estimate c� Water File Purveyor: n e d g�. U�1 �S No: Service Address of assenthlp Location of assembly on premise U Supply to: P YI n K I a s Owner of assembly: `Jfi Owner address: � � r 1 t r h QI-61 ZIP. Manufacturer: w5 Model No: Siu_L_Serial Stvle: RP O DCP DCDA O RPDA O PVB O SVB O Orientation New Svstem Pressure Install ? Reduced Pressure Principle Assembly at this location Y � SL PSI Double Check Valve Assemble -F Check71al7ye# 1 Check {alve#2 Relief!Valve PVB/SVB INITIAL held at PSID Held at Z•U PSID Air inlet TEST ' Opened at PSID opened at Closed tight �7— Closed tight 0-- Did not open O Opened Fulh•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 Cleaned O Replaced O FINAL Cln.ced tight Closed tight Opened at Air inlet TEST Leaked O Leaked O Did not open O Check Valve Comments: Initial test bv: Chris N Q S ► I Date: I b 23 Certifrcation/License# 13 AT 2 0 9 UJ Pass� Fail O Repaired/Cleaned by Date: Final Test by: Date: Certification/License# Pass O Fail O µ'aler service restored? N BAT Furor sample I%k HALKFLUW PkEVENIION ASSEMBLY IEST REPORT CUSTOMI R NAME SERVICE ADDRESS 1 C-1 r P r R LOCATION OF ASSEMBLY F-0 / SUPPLY TYPE OF ASSEMBLY f2l P NEW INSTALL ` PSI J`t7 MANUFALTUREK ! _ I MODEL Z ;ERIAL ,�� b y,9 Sl:a PVB/SVB CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE AIR INLET OPENED AT PSID INITIAL TEST HELDAT_/Q•/ PSID HFIDAT/t)PSID OPENEDAT 3-1 PSID OPENED FULLY -, CLOSED TIGHT d CLOSED TIGHT DID NOT OPEN r LEAKED LEAKED DID N01 OPEN c CHECK VALVE HELD AT _ LEAKED CLEAND CLEAND r CLEAND c CLEAND D REPLACED REPLACED REPAIR/FINAL HFI O AT MIC HELD AT PSID REPLACED REPLACED o � CLOSED TIGHT �_ OPENED AT PSID AIR INLE I OPENED AT__ PSID CLOSED I IGHT LEAKED - LEAKED r DID NOT OPEN CHECK VALVE HELD AT_ FAIL Nc IIS GAUGE 4 GZ G G MAKE AND MODE l I�,c% L'r CAI IBRA1ION DATE (� L TESTER v q 73✓ UCCN L dGGII� Z �J� 6 DATE G•LZ L REPAIRED BY DAI I V FINAL TEST BY 1 w LItEN1f DATE WATER PURVEYOR +-e Nash & Son RPM Ht At TON •LANDSCAPING•L XCaVATION f � _ 208.S00.9747 Call or Text for an Estimate