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PERMIT DOCUMENTS
7 ok5a & Utility Company 'boil Mrnn Liu,..b I Flamingo Plumbing & Backflow Services, LLC . • 2781 Vista Parkway 410 West Palm Beach. Fl 33411 State License CFC 056469 ' • State Fire License 15176300012009 INAME OF PREMISE: f uW4tC ! �/ratlr.4e: : L%.o __1NS*sisty t 1 �STREET ADDRESS: _ "ton t&clu r 1 tL (l e r' CITY 661 rb4n+ 19 64444. 1LOCATION OF DEVICE: SU) Col wC' OP bot.tIdin Manufacturer: LAI-W(01AX Model: ese -y-CL Serial No.: 19Slicccs Size: -Cif RP — DC . VB - AVB 1 AG — DOMESTIC 0 IRRIGATION O FIRELINE= PRESSURE DROP ACROSS FIRST CHECK VALVE - PSI LINE PRESSURE K PSI I CHECK VALVE =l CHECK VALVE 42 I DIFFERENTIAL PRESSURE PRESSURE VACUUM I •RELIEF VALVE BREAKER Intl I. Leaked _ 1. Leaked E Opened at LBS Air Inlet opened at PSI Test 12. Closed Tight _: 2. Closed Tight FE Did not open E Did not open Held at 2- / PSI Held at l ' 9 PSI CHECK VALVE PSI LEAKED _ R I Cleaned Cleaned • Cleaned E Replaced: ../ Replaced: Replaced: i ' Cleaned El P Rubber Parts Kir_ Rubber Pans KitGi Rubber Parts Kit _ Replaced: U A CV Assembly _ CV Assembly _ CV Assembly _ CV Assembly I OR OR OR OR . R Disc - Disc _ I Disk ! Disk Air Inlet C'• 0-Rings _ 0-Rings G7 Diaphragm FTDisc CV ❑ Seat _ Seat _ Seat _' Spring ❑ \\' Spring _ Spring -• Spring �� Retainer 0 li Stem/Guide Stem/Guide L-i Guide ❑ Guide R Retainer _ Retainer — 0-Ring ❑ 0-Ring El K Lock Nuts — Lock Nuts — Other 7 Other ❑ Other _ Other _ Final CLOSED TIGHT CLOSED TIGHT __ OPENED AT LBS SATISFACTORY n ITest - REDUCED PRESSURE I NOTE: ALL REPAIRS:REPLACEMENT SHALL BE COMPLETED WITHIN TEN (10) DAYS. IMETER 4:9 G675 @c Roa5 o2- ` TEST FAILED. What needs to be done: I o ii- b0.vu 1?Lv.4 Si.) 9 3 U 11 HEREBY CERTIFY THAT THIS IS ACCURATE AND REFLECTS THE PROPER OPERATION AND MAINTENANCE OF THE UNIT. mo day yr DATE / -' Jn Initial Test BY: _Bob D Torres ©� 1F' Certified Repair No. 131943 mo day yr Repaired By: j Certified Tester No_ 09 30 201 rin�l Tact Rn.