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HomeMy WebLinkAboutBP17-089 I Ya7K lSTATE:ICwa SARTMJI70FItakTH 9. Report on Test and Maintenance ru�df Puck K'atrH Suety ircr=C� e`r.4 v Stara Plan-C•�-�.na Taws�w'r t'!7 zap;,Ny122?i of Backflow Prevention Device ynar -- Please use aseparate form for oath device. '.rule I �Ie'dial too-CArnpiate amen:fa T. Annual lost-Comploto Par.A only PuSD:Water suCDt) I Aco's�r No. I Cco.r. I e:-1 Lit I I Fa C,,,I tomlfat or Devlw dGty Name �r�•el hkLcr Ct sit :,ddrers2,L) G�ns{ �.,,� RYe B<r�k tos�3 <�p�► sue zo Device I Atamfa]u er Typo �RPZ Model Size(In ImIM) Sertad Number Information DGv t; C)-.L-5 Zvi Cpt•}}-•}-O Chet vahM Nm 1 CIS Valve No.2 I DlRmenBal Prwtuaa Regd Line Prossure wl Vaho Test La3kvc rH� ;..eked 0 Oponad ajZ (_psld Date hetoro ClcsedCght I,y� gasoa ftht ®-. I repalr Pressure Crop acres&Urrs checit valve M D v 14 or Describe RupakW by nPam and Nauss 1117tC1'tals used / ( n Uc d An(/^ Datempalred: «! IV A mOm M D Y Final tost Closed tight _ Gescd Ught penoa sid Os Pro=wra drop acro:3 rant IN D Y Cned.va'e paiC 1M w mel Number Meter Raadlrg Typa of S cne) 9 Domestic 9 R 9 Other Rornar"(Dexroe ao6a.oc�Iaa�xt lry�p=m amen ware ca dam=—C-v W... u+e oree.ridcramm-7y.r+ar-2 o.,mgws•>tipasi.�1 Cordfrcebarc Thh device Lam-meets. 0 Coos NOT moot,the nequuemonu of an acceptable mnbinmenl de+Ace at tre teas of tateq 1 �� err 'the raw)ang dale to ae mm» 3. 31 r 20 Z f Few LJQ�}( 6}O nifi _T +c ny Q S O o'yl c•��^' F�Oif1SM Dr. Ptcps.'ty tribes tar c fflam/a-o7.nft ow"cation%at Wt xas Puff -. Q slut.._.._ 1L t'ale �.a...j? Ttl.l1b•e Gmtlfientbn Uwl(n--ftib tlon h(n namrdance with the approved Plans. (To.e mmok=4 ty er dn4m mplrser w arCCNd d.am :u=6m.I I fro"camv Curl u"hRaeatii b In eacwdaem weh are approved pmm Nam. RussellPIIIUtX1 acr psyp / 0 SI I !8 N"SCt•Log 4 Llcertso Number 78721-1 _ •6040 -m d y PdPN 11.pmwn.ng Prime 50imans, ri rT Da acnbo m nor wata.n•uon Chong.. Address 140 Princeton Drive uy, Shelton I V.0 27p 06 r i.-..trod ve lQy trs C,.•...era 0.•r.¢7y 5�►r r:s 0.yar.c.nu a aaya _b+rr4 ee.o. Homy or.r an.ern a7yw .6felr�r;.rny t6iF1e• a ec:_rt rY1.T.r.a•tystery x ma DOS idt3(Y7t)