HomeMy WebLinkAbout19020095 Backflow Test ResultsCity Of Carmel Backflow Test Form 1
-Submission ID 4136067892619812898
Submission Date, 2018-09-24 09:59:49
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Contact Us Form
When enterinqan,emaii,-r&;f(rst one-'-is,req'uirdd:�A-.notice -will 'be',sbnt to`idve-ry:email entered.,
Test6s1mall
Test ling:Cqrnpanys Email_
customers Email'
tony.hughes@grunau:us
brian.sauer@grunau.us
erin.shepherd@cushwake.com
TESTERINFORMATIONI-.
S(!16ct:T'e-steriFf6th;List-.1f.. HUGHESJONY BF11-4199
idsterls not on list, 'Select
The First,,!'Field Noton List"
and then, enter their'
information below,
Gauge Information 4152475
Phone Number (317) 872-7360
Calibration Date` 04-09-2018
Select Company or. Self Company
I
COMPANY. INFORMATION'S
I .
,Company -Name Testing For Grunau
PtibniMumber (317) 872-7360
ri Address 6011 East Hanna
Suite A
Indianapolis
IN
46203
.SERVICE TYPE
selecttService;Us6' Commercial
Resideihfia[ Information
Mang''gpr or.o--'C"--mth--er-c'ia-l:'Ih-fbrtnatibn
.,
DEVICE LOCATION Street name: Hamilton Crossing Boulevard
ADDRESS House number: 121302
City: Carmel
State: IN
Postal `code: 46032
Country: United States
HOAAnfo"rmatibn
Dev'i'C6- Ihsi:#Iff hforMAtidh-,
Existing, New or'Re
, pia.cing- Existing
Device -
Device Info'rm'aitibn
Ddvicei Serial Number:
21056
Manufa cturer,df cleviceL
Wilkins
DeVice;Slze
6.0
Model Number Of Device
375A
Type of protection
Containment
-type,of service
Domestic
Device Hazard Code-,
Hazard Code RP
'DeVice InitiM Test Pass, or Fall, Option
Selecting Pass will open, the Final Test Page and Fail will open Initial Test Page
Passed or Failed, Yes
DC!D- lniti'al;Tbst,Results,
DC.- Final Test R680ts
RP
"RIP',-Imitial Test -Results
RR'- Final Test Results
Check Valve]#1 Held AfWhat PSID,
66sied Tight
Leaked
Check Valve,#2 Held,At What PSID'
Closed Tight
� Did NOT Open
RP
8.0
y —
N
2.8
Y
At What PSID 1 5.2
Passed'or Failed Yes
Tagged YES
Date- 09/14/2018 11:30 AM
PUB lInitialTe.st Ae§Ults,
PVB - Final Test Results
AIR = Final Test; Results .
Sign and: Acknowledgement°
By signing this backflow'test report, I hereby certify that l am familiar with the information
contained in this form and that to the best of my knowledge and belief, such information is true,
complete and accurate at the time of the test.
Testers.Full Narne: Tony Hughes
Date 09/24/2018 9:50 AM
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