20240913SWS 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 [phone]
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: [phone] 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: [phone] 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: [phone] 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: [phone] 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: [phone] 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: [phone] 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: [phone] 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: [phone] Fax#: [phone]
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: [phone] _ Fax#: [phone]
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: [phone] 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: [phone] 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: [phone] 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: [phone] 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: [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 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: [phone] 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