Backflow Test 805 Bonita Rd IRR23-0013 • City of Atlantic Beach 'Assisi Lane
Atlantic Beach..FL 32233
BACKFLOW PREVENTER
TEST AND MAR,1TENANCE
Name of Premises: Rex McKinney _.._....Account No:
Service Address: 805 Bonita Rd Atlantic Beach, FL 32233
Mailing Address: 1432 St Johns Bluff Rd N Jacksonville, FL 32225
Contact Person: Phone No: (904) 242-8378
Type of Service: ci Process ci Fire c Domestic n Irrigation c3 Other:
Type of Assembly: RPZ Manufacturer: Febco
Model: 860 Serial No: 08737
Size: 1" Location: Foh
Gauge Manuf: Mid-West Serial No: 11221410 . Date CalibratedNerified: 01-16-2024
Check Valve#t Check Valve#2 Relief Valve PV13 or SV I3
x Closed tight Closed tight x t)ptn d ct Air inlet opined at la,i
at 7.8 psi at 2.4 psi at 3.0 psi o Did not open
5 Leaked Leaked Did not open Check Valve held at ...___ psi
a Leaked
Cleaned only Cleaned only Cleaned only a Cleaned 0111
Replaced: Replaced: Replaced: Replaced:
o Rubber Kit a Rubber Kit a Rubber Kit a Rubber Kit
o CV Assembly a CV Assembly a RV Assembly a CV Assembly
a Disc a Disc a Disc a Disc,Air Inlet
E a 0-Rings a 0-Rings a Diaphragm (s) a Disc,CV
v
a Seat a Seat a Seat a Seat.CV
a Spring a Spring a Spring a Spring.Air Inlet
o Stem/Guide a Stein/Guide a Guide a Spring,CV
a Retainer a Retainer a 0-Rings a Guide
a Lock Nuts a Lock Nuts a Other,Describe a Retainer
e Other.Describe a Other.Describe a 0-Rings
a Other.Describe
Closed tight at Closed tight at Air inlet psi
Opened at psi
____psi _ _psi Check valve . _psi
Remarks: Installed b others
I certify that the data in this report is accurate.
Tester Name(print): James (Jim )Share Date: 04-20-23
Tester Signature: " Phone No: 904-268-8009
Affiliation: TREED Cert No: J06-22-14853
Tester Company: Bob's Backflow& Plumbing Services, Inc. Address: 4640 Subchaser Ct, Ste 113
THIS ASSEMBLY: IN PASSED ❑ FAILED 7,':"8.':01 0 GS