HomeMy WebLinkAbout3/27/2002 bfp20evansIOWA OTY - PUBLIC DRINKING WATER PROGRAM
BACKFI~OW PREVENTION ASSEMBLY TEST DATA AND MAINTENANCE REPORT
StJ pet. y ~ESSLJ~E
StJPPLY . IN, G~P
IN.
SERIAL NUM~iER
INITIAL TEST Passed Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY: ~ []
I ST CHECK held in
direc:ion of ,,ow (~.'7 PSID
RELIEF VALVE
opened at ,~-' PSID (2 PSID or more)'¢~,.~' []
DIFFERENCE
(lst check - relief) f/.(~ P:-;ID (3 PSiD or more),./,-'Z~ []
2NO CHECK held backpressure .,,B'/ []
NC.. 2 SHUTOFF VALVE leak tight '/J~ []
2ND CHECK held in
/
direction of flow [_ov~' PSiD (1 PStD or more) /Z~- []
RELIEF VALVE exerci~-~d"-~o full open position __~__ []
NOTE: Failure of any of the above items, requires repair.
FINAL TEST AFTER REPAIR Passed Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY: []
1 ST CHECK held in
direction of flow PStO (5 PSID or more) [] []
RELIEF VALVE
opened at PSID (2 PSID or more) [] []
DIFFERENCE
(1st check - relief) PSID (3 PSID or more) t-i J []
2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE Teak tight
2ND CHECK held in
direction of flow PSID (1 PSID or more) [] []
RELIEF VALVE exercised to full open position [] []
INITIAL TEST Passed Failed
[3OUBLE CHECX VALVE ASSEMBLY: [] []
i ST CHECK held in
direction of flow PSiD (1 PS1D or more) 12 []
2ND CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tight CT []
2ND CHECK held in
direction of flow PSID (~ PStD cr more) [] []
NOTE: Failure of any of the above items, requires repair.
FINAL TEST AFTER REPAIR Passed Failec
DOUBLE CHECK VALVE ASSEMBLY: D O
1ST CHECK held in
direction of flow FSID (1 PSID cr more) [] []
2NO CHECK held backpressure [] []
NO. 2 SHUTOFF VALVE leak tight [] []
2ND CHECK held in
direction of flow PSID (1 PSID or more) I:2 []
INITIAL TEST
PRESSURE VACUUM BREAKER: Passed
!nternai check held tight in direction of flow
PSID (1 PSID or more) []
Inlet Poppet opened at PSiD
I1 PS1[} or more) ID
NOTE: Failure of any of the above items, requires repair.
APPROVED APPUCA TIGNS ONLY
Failed
[]
[]
FINAL TEST AFTER REPAIR
PRESSURE VACUUM BREAKER: Passed
Internal check held tight in direction of flow
PStD (1 PSID or more) E:
Inlet Poppet opened at PSID
(1 PSID or more) []
INITIAL TEST
ANTI-SPILL VACUUM BREAKER: Passed
Differential pressure across check w~s
PSiD (1 PSiD or more) []
~ir ~nlet start to open at PStD
!i PSIO or mcre) D
Air iniet fully open when supply pressure
atmospheric []
NOTE: Failure of any of the above items, requires repair.
,z, PPNC VE~, A??L/CA 7'/C/VG ONLY
Failed
n
[]
FINAL TEST AFTER REPAIR
ANTI-SPiLL VACUUM BREAKER: Passed Faile
Differential pressure across check was
PSID (1 PSi[3 or more) 0 []
Air inlet start to open at PSID
(1 PSID or more) ID ¢2
Air inlet fully open when supply pressure
atmospheric C 0
C O M M E hi T S
FEPA, iR HISTORY
THE ABOVE REPORT IS '~:ERTIFIED TO BE TRUE. ACCURATE AND FOM, PLETE/.
~X Bo~s Co., ~nc. 2865 Stoner Court,