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Home My WebLink AboutBackflow Test Results�11Vi].0 LV YY rrLr Vr11V11V1V LP01 ADDRESS CITY ZIP BUSINESS/RESIDENCE TELEPHONE MAKE & MODEL SERIAL # SI4E LOCATION NEXT TEST DATE BY REDUCED PRESSURE ASSEMBLY RP' DOUBLE CHECK VALVE DC PVB CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB/SVB SVB INITIAL DCDA : TEST Held at PSID Held at PSID Opened AIR INLET RPDA at _ ' ' PSID Opened AG at PSID AVB Closed tight SUPPLY I2Uot Did Not PRESSURE Leaked Leaked 31 Open CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not Leaked Open CLEANED AIR GAP REPLACED Pipe _ Size _ Dist. FINAL PSID PSID Opened PROTECTION SERVICE 0 Containment ❑`Domestic TEST Closed at _ PSID ❑ Isolation ❑ Fire tight ❑ Containment ❑ Irrigation by Isolation INITIAL TEST BY: TESTER No. I95-0896 DATE: Phone: (317) 258-6118 Fax: (317) 566-0087 TIME COMMENTS: ��, / c� f Tq- _ r ` . D 0 v c h 0—' 'tW I 4 c GAUGE: MIDWEST MODEL: 830 305866 213008 CALIBRATED: Ayers Backf low Check Service 20 BENNETT ROAD • CARMEL-, INDIANA 46032