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