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BACKFLOW PREVENTION DEVICE TEST REPORT "~PLACEMENT <br /> <br />NAME: <br /> <br />ADDRESS: .... <br /> <br />DOUBLE CHECK VALVE <br />CHECK # 1 CHECK #2 <br /> <br />CHECK #1 <br /> <br />BREAKER <br /> <br />AIR INLET CHECK <br />OPENED AT PRESS BROR <br /> <br /> DID NOT LEAKED <br /> OPEN I'~ [] <br /> <br />INITIAL TEST <br />FAILED [] <br /> <br />TIGHT <br /> <br />[] TIGHT <br /> <br />[] I J J*~s,o OPENED AT <br /> RELIEF' OPEN ~ /~ · k.._J P~I~ <br /> <br />PRESS DROP <br />L_L_J ' l...I P~O <br /> <br /> AFTER REPAIR <br />DATE: I L J/'L..~b/L~ <br /> <br /> DETECTOR METER READING <br />IN COMPLETING AND SUSMI1TING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE <br />DEVICE HAS SEEN TESTED AND MAINTAINED IN ACCORDANCE WIYH ALL A~h~LICABLE <br />RULES AND REGULATIONS OF THE WATER SYSTEM OWNER AND TNE Si'ATE OF OREGON. <br /> <br />(REPRESENYATZVE OR FIRM) <br /> <br />WATER SYSTF_.~S COPY <br /> <br /> <br />