HomeMy WebLinkAbout238367 10/21/14 CITY OF CARMEL, INDIANA VENDOR: 357442
ONE CIVIC SQUARE FLOW CHECK INC CHECK AMOUNT: S".....'85.00"
CARMEL, INDIANA 46032
8304 W 87TH ST CHECK NUMBER: 238367
9, ,roN INDIANAPOLIS IN 46278 CHECK DATE: 10/21/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350100 1480 85.00 BUILDING REPAIRS & MA-
FU6WCHECK INC.
® s
Cross Connection Service &Testing invoice
C
8304 W. 870' Street
Indianapolis, Indiana 46278 i
(317) 293-4598 Phone/Fax lyo ld_ 20,Al
a C/(//C- -sQt.4 4i c
cuer?EL, /N qw 3 2,
TERMS: NET DUE 30 DAYS
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14=j QUANYtTY - DESCRdPTIOM UNrr:'PRdCE -tAMOUNT
6e4! Co.v�cr TrO�c/ ��sTS95
TOTAL �S,nO
Account No. : Premise No.
LOCATION INFORMATION DEVICE INFORMATION
Service For: C"Agmet— orige,D6,ar 1WQ P7
Type ofAssembly. e
AssembleAddress 1: Serial : /2SV401L Size :
C "C-4— 1 441
Address 2: ft eWID'&*2, N-117G/Model No:
LAAM
Type of Servico: Domestic Fire 0 Irrigation Water Meter No:
Lo,cafion ot'Device: W05-'r VT14-1-f( roan Isolation —)ntainment Q.-I
New Assembly M Replaces Serial No:
TESTMEASUREMENTS
DC RI) PV13/,SVB
Check Valve#I Check Valve#2 Pressure Diff.Relief Air Inlet
Valve
Initial .11PSID Heid at PSID )e at Opened at
• PSID PSID
)ate: 10-114-2- 014 Closed.I,ighl ge"aked C]
Time: —66GO Closed Ti--ht #2 Shut Off"Valve Closed Tiuht? Did Not Open E) Did Not Open F�
inc prc". Lirc: Leaked E] Yes V No 1j, Check Valve Held
PSID
Final Held at Hcldat—PSID Opened at Opened at
Date: .PSID PSID PSID
Closed Tight E]Leaked E]
Closed Tight ]
Did Not Open E] Did Not Open
rime: #2 Shut 017 Va'lve Closed Tight?
Line pressure; Leaked Yes 0 No El Check Valve Meld
PSID
leasured vertical inches Upply
AIR GAP size diameter
jabove overflow rim
IS
COMMENTS(including maintenance performed)
44- yce,0 727 /c/144
TESTER INFORMATION
INITIAL Tester Name
Si2nature =7 9/7,29S 9-Sm"'700
Certified Tester No.: 40-7 4 9 4 073
Testing Equipmefit.Calibration Date: ens OD
3 .�8Apoiq
resting Equipment Serial Number:
4" FAIL
FINAL Tester Name Company
SiEmature Certified Tester No.:
Testing Equipment Calibration Date:
FLOWGIiECK,INC. DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
backflow preventers Registered Cross Connct:Von Control Device inspector
service and testing of
State Form 51075(10702)
Registration No. Card No. 982 .
8304 W 87th St.
1 94-0731-
Indianapolis, IN 46278
JAMES INLINVILLE
8304 W-87TH ST
ilNID ANAPOLIS,-IN 46278=1104
JAMES LINVILLE
Rick Miranda
Certified Tester/Cross Connection Spectctlist
Cross Connection
-Contol Program
flowcheckinc@gmail.com. 317 293 4598
IDEM#BF94-0731 FAX 317 293 4598 Drinki6g Water Branch
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1480 $85.00
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Flowcheck Inc.
IN SUM OF $
8304 West 87th Street
Indianapolis, IN 46278
$85.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 1480 43-501.00 $85.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund