PERMIT DOCUMENTS I
1
/ 2 '2 • fl57 Utility Company )3 tAfre) di
Flamingo Plumbing &
Backflow Services
2781 Vista Parkway 410
West Palm Beach.Fl 33411.
State License CFC 1426338
State Fire License FPCI7-000070
NAME OF PREMISE: rJ/cist-Zit_ e/in 6 T/ p1'`- n4 /iVts_-.
STREET ADDRESS: et 7'd 50 V rw ft..Q an top jn 4/
LOCATION OF DEVICE: D y #0 v et 0A 4J 0►27-31
Manufacturer. (AJ!LCL/.rt/S — Model: 97+ Y L Serial No.: 4/37 SY y 16 Size: i y
RPX DC L PVB i .Avn _ AG I DOMF_STIC Pici IRRIGATION S FIRELINEC
PRESSURE DROP ACROSS FIRST CHECK VALVE ?f PSI LINE PRESSURE 6 r PSI
• CHECK VALVE,aI CHECK VALVE f2 ' DIFFERENTIAL PRESSURE PRESSURE VACUUM
RELIEF VALVE BREAKER
Intl I. Leaked - I. Leaked 0 Opened at 4.L LBS Air Inlet opened at PSI
Test 2.Closed'nal 2. Closed Tight a Did not open LI Did not open 0
Held at O� PSI Held at .02, ti PSI CHECK VALVE PSI
LEAKED _ 1
R Cleaned - Cleaned _1 Cleaned N
E Replaced: _ Replaced: _ Replaced: _ Cleaned 0
P Rubber Parts Kit_ Rubber Parts Kit Rubber Parts Kit - Replaced: t 1
A I CV Assembly : CV Assembly CV Assembly _ CV Assembly 1
1 OR OR OR OR
R i Disc rt Disc .❑ Disk i] Disk Air Inlet _i
O-Rings _ 0-Rings U Diaphragm 0 Disc CV i i
Scat = Scat 1 Seat 0 Spring. • 0
W Spring _ Spring _ Spring _ Retainer 0
0 Stem:Guide - SIemrGuidc _. Guide 0 Guide ._
R Retainer E Retainer 1 '' 0-Ring
0-Ring !
K Lock Nuts I.: Lock Nuts !1 •Other
Other 0
Other - Other
Final CLOSED TIGIIT _- CLOSED TIGHT E OPENED AT LBS SATISFACTORY _1
Test i REDUCED PRESSURE
NOTE: ALL REPA S!R P %TENT SHALT.BE COMPLETED WITHIN TEN(10)DAYS.
METER -. /'i /ZfsM — 000Gaddl /
o TEST FAILED. What needs to be done:
1 HEREBY CERTIFY THAT THIS IS AC TE AND REFLECTS THE PROPER OPERATION AND MAINTENANCE OF
0 TIIE UNIT.
1 mo day yr
DA1 Z5 18
Initial Test By: _Dave Hansen t
Certified Repair No. 16056 mo day yr
',Repaired By:
Certified Tester No. r I 9 carli7
;Final'Fest By: —