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✓ <br /> ASSE International RECEIVED <br /> Reduced Pressure Principle Backflow Preventer(RP) MAY 1 � 2017 <br /> ASSE Standard#�1013 Field Test Report <br /> � CITY 0�ORONO <br /> Owner of Property � ' $ <br /> Address y ����` ��- <br /> �f.xp� �"y. <br /> Cilh/ �1r�1 V�n i � �� <br /> ., ' {�te ' Zip Code <br /> Occu arrt of Pro e �� ' "���� ` <br /> P P rtY(if different from own�r) _. ,�,;s,�,�.�..���. H-- <br /> Occupant Address �,;�_ <br /> City St�t�, Zip Code <br /> Manufacturer of Assembly:,�i (k( h � 4 Model#: Q ?�J ��.... <br /> Size of Assembiy: � �' Serial#: y <br /> Location of Assembly and Equipment or System Application: ' � <br /> Test EquipmeR: l '' <br /> Manufacturer:�i C�-�IUes-�' Model#: _$y S -S Se��#: b� � �- y�a <br /> Calibration Date: 3-l5-'a.01 �- <br /> Date test was perFormed: 5 �1 I� Time test was perfiormed: ��Cc.lM Static Line Pressure: "7� � <br /> Check Valve#2 Shutoff vaNe#2 Checic Valve#1 P�Sure Differential <br /> Relief Vaive <br /> Leaking ( ) <br /> Initfal Test �aking ) Leaking ( ) Closed TigM (� <br /> Closed Tight � Closed Tight � Pr+essu�s Drop Across Opened at_psid <br /> , q .5 cn�vawe� sia . <br /> u����� q ,°t -� <br /> and repairs <br /> when needed <br /> Leakin9 ( ) <br /> Closed Ti ht <br /> Final Teat Cj s�Tight ( ) Closed TigM ( ) P�'°�ure Drop Across Opened at_psid <br /> Check Valve#1 sid <br /> Certified Tester( rint) 1 ' Assembly Final <br /> Address � v� Test Performance <br /> . <br /> Ciry�,�v�v�i�Gz State I�iV Zip �5 (p P� <br /> Phone#: 5 - q - <br /> �icense#: ? ce�t�ication# 3`�3$�o Fail � <br /> Signature Date: �� � ? <br /> Comments or Recommendations(conttnue to otner s�ae,ff neeaed): <br />