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HomeMy WebLinkAboutBP17-088 OqX SH7 rr_fr,atP u,.1-S. r"-of"`T`n' Report on Test and Maintenance arn1,or T,Guc WYer�+AGr Prye,2on Fep✓e Stab il��-C-zri.;To.a-Saar t•i 7 At-,yY 127-rT - of Backflow Prevention Device r the year Please use a separate farm for each device n• lnhial raa:•Camdotaanfro/drn Annual t051-Complolo ParhA only cuuue Waror 9u>r wcmrino. Cm,r-r I ebcY le: -I f 1 Lodbn d Devt FwGry Nana I<l(1q�i c1 G+- Ad_ran. tt V,4LF P_ ts►4C R rt= 3non!< te513 c���i��(e� Cjc.,5e SUMZo Device Llarwfadunar Type o RPZ Mom Stu(in hdtes) Serial Number lydarmauon 1.J�11L•tn� I VIOCV I 45a X� ! 2r' Co k7?! Chu*VatVs Na t Check Valve No.2 OlRerardw Prossura Relief Lino Preaaula_del Vafry Teat _ ttUmkod t Date Ware, Clesod tight �XJ mno tight tCl Opened at_ _Psld � ® [I �r CJ toss ® Pressure drop adore first check vWvo M D Y _3_V_paid Describe Ropafred by ttaplth and Name makdale used LIc 9 J !A + w( /p l� Pate rspaMsd: 1 � I�11T1 m � m hl D y Rraa)mat Do3ed bgtlt Grad light Opened at 3- psid 1 ' O S Pressure drnp ache fast 1 N D Y chack valve p.ad Water Meter Nunbc Meier Reading Type of Sam=(check me) 9 DwnG.Y_ 9 cu'ar Ramorkn(0-aft dt,zdandea.0y;=u&uAets aII roteM t &.ka L m.be ae we arAm am poem d.ry.lz; a- .kg .•�) Cowl"'C auem Tttid dovka mc.da• lJ ow NOT mect.t•-.rCCwumCn!3 Clan manse con:ainrnent de-Am.it the time o(temt rg roragd9rg tiara to ao can DC. �Sa ` Name Oea Prep"gw (a errs agent)0"Oreaton that la s was perfumed: '►1�'1j',;� ��.J>—, . !t'16rL tq�i?Z-`} Sc17o 1•*1.1 Name Tltlo Tel rpndne CtJtificaticn that ifoWlaWn b In aearden m-0 the approved DLart& (To W maolewd by dr durpr cngbx auotiir.l 1 hereby cnrt.�r OWorb k-a�an d Le i wan tAe approved plant• Nnmo Russell Palu.�' gineer ' / O S e Nye ct-Lag e UcanaoNumEer 78721-1� P EUGE, D 'S)3378040 m d Aapratominp nrTle 0 u ! �ers OeaalEo mina+in dldlalion diungm Addreea 140 Prineetont G y 5hellOn 06484 • C�t trrP7 W rrla' fgia3tl-Lit tt4r aM rzJy J CL r2fa is:.+ar YI.n t�1S aa'4Jp a*o- uornr aver t��aW Orr� .��'J�e leis trtt ay rrns:n can.Y.�+ne'..u]C rUwu: 004- 1013(WW1)