HomeMy WebLinkAbout2023-11-01 AIE Inspection Services Backflow Preventin Assembly Test Report Please print all AI E Inspection Services,neatly p Inc.
Backflow Prevention
6 Is Heel ! IU Assembly Test Report
Inspected By
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mil 4.4r-n,r,e id t'"i 5.5-4, 7 Certification/
Manager 5 ez r} r c e pc c.I-- Phone s'o l t yy_ 5-%6 License# r 6.3 c S '-5- Time /, 6u fes"+
Phone 6;5 `yl 3 y -74 7t
Cert Exp Date/:2 `3i -)-3
Alarm Co. r- Alarm Phone
Location(Circle all that apply): 1�nside` Outside Above Ground Pit
Describe location(Please be spe I cc: Usage: Domestic Irrigation
Mfg Model Size Serial#
Type(circle): J DDC DDC-bypass RPZ RPZ-Det RPZ-Det-bypass Afr1e.5 c r„5 8 „ // r��-3
Orientation: Vert Up Vert Down Horizontal Protection: Containment Isolation`s Height off , Meter/Acct# L4
Floorif (in/ft)
REDUCED PRESSURE PRINCIPLE ASSEMBLY Date
* Relief ports on RPZ free of continuous discharge?(circle One) Yes No Installed
Double Check Valve Assembl Pressure Difference Date
Y (1st ck-relief) Rebuilt I/-11-'1
J- .3
CHECK VALVE#1 CHECK VALVE#2 RELIEF VALVE PVB/SVB
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Q t1�
Held at i ' PSID Held at A.2 ' 8 PSID Opened at PSID AIR INLET
z Leaked 0 Closed Tight ..# - Did Not Open 0 Opened at PSID
Leaked 0 Did Not Open ❑
❑ Cleaned 0 Cleaned 0 Cleaned ❑ Cleaned
co a- Replaced: RI Replaced: 0 Replaced: ❑ Replaced:
ccw
R. 0
wm
cc
p ` PSID PSID Air Inlet PSID
z r
it PSID Check Valve PSID
Closed Tight Leaked 0
PASS -- FAIL No.2 Shutoff Valve Supply Pressure '
Closed Tight ,,�
Leaked ❑
Forward Flow Test Performed(circle one): Yes or No
If Performed- Designed Flow Rate: GPM Actual Flow Rate: GPM
Note: Include hose stream demand where applicable
Please note if attempted cleaning,flushing or unclogging of test cocks.
Fepjft'lea a3(TA ` i 4— > : -- Ck.<(-')< t;` -)i*E)
Test Kit Make t v i 6 k'e-ST”" Model e Ii5 -;�
Serial # I) ; --), 16 Last Calibration Date la.-3' ,-Aa—
Z--Certification Tag Placed on BFP at Completion of Test :F2-. BFP in Service
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Inspector's Signature Customer Signature Print Name & Title
1314 Hwy DD, Defiance, MO 63341 (636)398-5288 Fax:(636)828-4634 We're fired up
Distribution: WHITE COPY to AlE,1314 Hwy OD,Defiance,MO 63341/Inspector to work
YELLOW COPY to STORE for you!
BFP Report Rev 0611-AIE