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✓ <br /> ASS E I nter � RECEIVED <br /> national <br /> Reduced Pressure Principle Backflow Preventer(RP) MAY 1 � 2017 <br /> ASSE Standard#1013 Field Test Report <br /> �. CITY OF ORONO <br /> Owner of Property � ' ,5' <br /> Address k�,, ... <br /> �.�• �-:;,'" <br /> City � �, � �tA Zip Code <br /> r% x��, . <br /> Occupant of Property(if different from own�r) ;. �;��z,�;;,,�,@,��,� � <br /> Occupant Address <br /> City �- :,St�t$, Zip Code <br /> Manufacturer of Assembly:��1 ��( � S ' 4 Model#: q 7�J x� <br /> Size of Assembly: � �' Serial#: y <br /> Location of Assembly and Equipment or System Application: �,� �; .. �,�.��,� A A� ,�� <br /> Test Equipmen: <br /> Manufacturer:�i�-�/�tes� Model#: �y 5 -S Se��#: b� � �- y�a <br /> Calibration Date:�-l5-a.0 1 �- <br /> Date test was pertormed: =3 �1 I� Time test was pe�fonned: ��Gc_fM Static Line Pressure: � � <br /> Check Valve#2 Shutoff vaNe#2 Check Valve#1 P�ure Differential <br /> Relief Valve <br /> Leaking ( ) <br /> Initial Test �aking ) Leaking ) Closed Tight Opened at�sid <br /> Closed Tight � Cloaed Tight (� Pressure Drop Across <br /> . .s ���awe�, s�d a . <br /> ������� � ,°� -� <br /> and repairs <br /> when needed <br /> Leakin9 ( ) <br /> Final Test �aking ( ) Leaking ( ) Closed Tight ( ) <br /> Closed Tight ( ) Closed Tight ( ) P��ure Drop Across Opened at_�1sid <br /> Check Valve#1 id <br /> Certified Tester(print) 1 l Assembly Finai <br /> Address `� v� , Test Performance <br /> City_���v�v��`�(2� State�l N Zip �S�(p Pass <br /> Phone#: 5 - q - <br /> License#: _ 7 Certification# 3`�3g�0 Fail � <br /> Signature Date: (� � 7 <br /> Comments or Recommendations(con�n�to other side,ff needed): <br />