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HomeMy WebLinkAbout3/27/2002 bfp15nvanburen)WA CITY - PUBLIC DRINKING WATER PROGRAM ACKFLOW PREVENTION ASSEMBLY TEST DATA AND MAINTENANCE REPORT ~Yl~ OF -4E~GHT OFF FLOOR TIME: J~J A.M. ] SUPf~.Y PRESSURE MANUFACT~FR MOO6L ~OTECTION FROM: FRE~ING ~YES ~ NO FLOOO[NG ~ES ~ NO AIR GAP 12 x SUPPLY DIAM ) SUPPLY s~zE '~/F ~ COMMENTS: IFILE NUMBER METER NUMBER IN. GAP ~PASS IN r-I FAIL SERIAL NUMIBER -7 INEW INSTALLAT~O~ [] YES ~-NO INITIAL TEST Passe/d Failed REDUCED PRESSURE PRINCIPAL ASSEMBLY: E~ [] ISTCHECK heldin ~_ j~ direction of flow PSID (5 PSID or more) . [] RELIEF VALVE .~ opened at _ ~ PSID (2 PSID or more) I~ [] DIFFERENCE (1st check - relief) ~-'~ PSID (3 PSID or more) /1~ ' [] 2ND CHECK held backpressure [3'/ [] NO. 2 SHUTOFF VALVE leak tight IZ/ [3 2NDCHECK heldin/ _~..p E~ direction of flow .. SmD (1 PSID or more) [] RELIEF VALVE exercised to full open position [] FINAL TEST AFTER REPAIR Passed Failed REDUCED PRESSURE PRINCIPAL ASSEMBLY: [] [] 1 ST CHECK held in direction of flow PSID (5 PSID or more) [] [] RELIEF VALVE opened at PSID (2 PSlD or more) D [] DIFFERENCE (1st check - relief) PSID (3 PSID or more) [] [] 2ND CHECK held backpressure [] [] NO. 2 SHUTOFF VALVE leak tight [] [] 2ND CHECK held in direction of flow PSID (1 PSID or more) [] [] RELIEF VALVE exercised to full open position [] NOTE: Failure of any of the above items, requires repair. INITIAL TEST Passed Failed DOUBLE CHECK VALVE ASSEMBLY: [] [] 1ST CHECK held in direction of flow PSID (1 PSID or more) [] [] 2ND CHECK held backpressure [] [3 NO. 2 SHUTOFF VALVE leak tight [] [] 2ND CHECK held in direction of flow __ PSID (1 PSID or more) [] [] NOTE: Failure of any ;3f the above items, requires repair. FINAL TEST AFTER REPAIR Passed Failed DOUBLE CHECK VALVE ASSEMBLY: [] [] 1ST CHECK held in direction of flow PSID (1 PSID or more) [] [] 2ND CHECK held backpressure [] [] NO. 2 SHUTOFF VALVE leak tight [] [] 2ND CHECK held in direction of flow PSID (1 PSID or more) [] [] INITIAL TEST PRESSURE VACUUM BREAKER: Passed Internal check held tight in direction of flow PSID (1 PSID or more) 1:3 Inlet Poppet opened at ~ PSID (1 PSID or more) [] NOTE: Failure of any of the above items, requires repair. INITIAL TEST APPROVED APPUCA TIONS ONLY Failed ri APPROVED APPUCA TIONS ONLY FINAL TEST AFTER REPAIR PRESSURE VACUUM BREAKER: Passed Failed Internal check held tight in direction of flow PSID (i PSID or more) [3 [3 Inlet Poppet opened at PSID (1 PSID or more) [3 [] FINAL TEST AFTER REPAIR ANTI-SPILL VACUUM BREAKER: Passed Failed Differential pressure across check was PSID (1 PSID or more) [] ID Air inlet start to open at __ PSlD (1 PSID or more) [] [] Air inlet fully open when supply pressure atmospheric [] [] NOTE: Failure of any of the above items, requires repair. ANTI-SPILL VACUUM BREAKER: Passed Failed Differential pressure across check was PSID (1 PSID or more) [3 [] Air inlet start to open at PSID (1 PSID or more) Air inlet fully open when supply pressure atmospheric [] COMMENTS REPAIR HISTORY AI~ID COMPLETE. THE ABOVE REPORT Ir~S CERTIF'ED TO BE TRUE' ACCURATE yn~u~ Date ;/93 - hisbJg~drinkw~r. Ffrn o~WueUT~O~: w~err~ . wATi~I~ suem.~a; ~'eLLOW · OWN~a; eeac · IOWA CITY - PUBLIC DRINKING WATER PROGRAM BACKFLOW PREVENTION ASSEMBLY TEST DATA AND MAINTENANCE REPORT SERVICE LOCATION . ~ ~ M~ER NUMBER · IIN./FT.IFREE~ING I~r YES n NO FLOODING Y[~ES [] NO [] YES [~ NO INITIAL TEST Passe/d Failed FINAL TEST AFTER REPAIR Passed Failed REDUCED PRESSURE PRINCIPAL ASSEMBLY:E~' [] REDUCED PRESSURE PRINCIPAL ASSEMBLY: [] [] 1ST CHECK held in ~~ 1 ST CHECK held in direction of flowu PSID (5 PSID or more) ~' [] direction of flow __ PSID (5 PSID or more) [] RELIEF VALVE RELIEF VALVE opened at~j,f_/3 PSID (2 PSID or more) El/ [] opened at __ PSID (2 PSID or more) El [] DIFFERENCE DIFFERENCE (1st check - relief) ~-~- PSID (3 PSID or more) I~ [] (1st check - relief) __ PSID (3 PSID or more) [] [] 2ND CHECK held backpressure i~ [] 2ND CHECK held backpressure [] [] NO. 2 SHUTOFF VALVE leak tightI~ [] NO. 2 SHUTOFF VALVE leak tight [] [] 2ND CHECK held in~ ~ ,¢,~~, 2ND CHECK held in direction of flow ~.(-- PSID (1 PSID or more)~ [] direction of flow __PSID (1 PSID or more) [] [] RELIEF VALVE exercised to full open position [] RELIEF VALVE exercised to full open position D [] NOTE: Failure of any of the above items, requires repair. INITIAL TEST Passed Failed FINAL TES'~ A'FTER REPAIR Passed Failed DOUBLE CHECK VALVE ASSEMBLY: [] [] DOUBLE CHECK VALVE ASSEMBLY: [] [] 1 ST CHECK held in 1ST CHECK held in direction of flow PSID (1 PSID or more) [] [] direction of flow PSID (1 PSID or more) [] [] 2ND CHECK held backpressure [] [] 2ND CHECK held backpressure [] [] NO. 2 SHUTOFF VALVE leak tight [] [] NO. 2 SHUTOFF VALVE leak tight [] [] 2ND CHECK held in 2ND CHECK held in direction of flow PSID (1 PSID or more) [] D direction of flow PSID (1 PSID or more) [] [] NOTE: Failure of any of the above items, requires repair. INITIAL TEST APPROVED APPUCA TIONs ONLY ! FINA'L TEST AFTER REPAIR " PRESSURE VACUUM BREAKER: Passed Failed PRESSURE VACUUM BREAKER: Passed Failed Internal check held tight in direction of flow Internal check held tight in direction of flow PSID (1 PSID or more) [] E! PSID (1 PSID or more) El [] Inlet Poppet opened at~ PSID Inlet Poppet opened at~ PSID (1 PSID or more) [] n (1 PSID or more) [] [] NOTE: Failure of any of the above items, requires repair. INITIAL TEST APPROVED APPLICATIONS ONLY FINAL TEe'I; AFTER REPAIR ANTI-SPILL VACUUM BREAKER: Passed Failed ANTI-SPILL VACUUM BREAKER: Passed Failed Differential pressure across check was Differential pressure across check was PSID (1 PSID or more) El [] PSID (1 PSID or more) [] [] Air inlet start to open at ~ PSID Air inlet start to open at __ PSID (1 PSID or more) [] [] (1 PSID or more) [] [] Air inlet fully open when supply pressure Air inlet fully open when supply pressure atmospheric [] [] atmospheric [] [] NOTE: Failure of any of the above items, requires repair. COMMENTS REPAIR HISTORY THE ABOVE REPORT IS CERTIFIED TO BE TRUE, ACCURATE AND_COMPLETE, . · , · 7f Date Date 3193 - hisblg\drinkwtr. Frm O~TR~UT~ON: ~ - WATER SUPRMER; YEU.O'~ - OWNER; PINK - TESTER