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340 2nd st backflow test reportCity of Atlantic Beach BACKFLOW PREVENTER TEST AND MAINTENANCE REPORT 902 Assissi Lane Atlantic Beach, FL 32233 Name of Premises: Mike Chamberlain Account No: Service Address: 340 2nd St. Atlantic Beach, FL 32233 Mailing Address: 1474 3rd st. south Jacksonville Beach, FL 32250 Contact Person: Mike Phone No: 904-400-4173 Type of Service: irrigation Type of Assembly: RPZ Manufacturer: Febco Model: 860 Serial No: Hal 1944 Size: 1" Location: Left side house Gauge Mfg: Mid -West 11) No: 02180103 Date CalibratedNerified: 05-16-2023 Check Valve #1 Check Valve #2 1 Relief Valve I PVB or SVB Tester #2 name: Affiliation: Tester Company: This assembly: � Passed C Failed Tester Signature Cert # Addr. Date: X Closed tight at [XX Closed tight at © Opened at 2.4 ❑ Air inlet opened at psi 6.4 psi 1.5 psi lbs reduced pressure El Did not open Check valve held at psi ❑ Leaked Leaked ❑ Did not open ❑ leaked ❑ cleaned only ❑ cleaned only cleaned only ❑ cleaned only Replaced: Replaced: Replaced: Replaced: rubber kit rubber kit ❑ RV rubber kit ❑ rubber kit ❑ CV assembly l 1 CV assembly ❑ RV assembly ❑ CV assembly ❑ or or or disc, air inlet ❑ disc [ disc ❑ disc ❑ disc, CV ❑ • O -rings O-ringsEldiaphram(s) E]seat, CV ❑ Seat ❑ Seat ElElseat El El spring, air inlet ❑ P4 spring ❑ spring El El CV El stem/guide Fstem/guide El guide El ❑ retainer C retainer El 0-ringsElgu1de ❑ lock nuts ❑ lock nuts El Other ❑ O -rings Other ❑ Other ❑ Other Closed tight at Closed tight at Opened at Air Inlet psi psi psi Check valve psi w Remarks: I certify that the data in this report is accurate: Tester name: Matthew Smith Tester Signature Date: 06-01-23 Affiliation: Cert P J02-23-10852 Phone No: 904-268-8009 Tester #2 name: Affiliation: Tester Company: This assembly: � Passed C Failed Tester Signature Cert # Addr. Date: