1604 Linkside Dr IRR23-0015 - Backflow Preventer TestV/23 _cot
City of Atlantic Beach 902 Assissi Lane
Atlantic Beach,FL 32233
BACKFLOW PREVENTER
TEST AND MAINTENANCE REPORT
Name of Premises: Clark Residence Account No:
Service Address: 1604 Linkside Dr Atlantic Beach, FL 32233
Mailing Address:_1432, t Johns Bluff Rd N Jacksonville, FL 32225
Contact Person: Phone No:
Type of Service:
Type of Assembly:_RPZ Manufacturer: Febco
Model: 860 Serial No: 14532
Size: 1" Location: LSH
Gauge Mfg: Mid-West ID No: 02180103 Date Calibrated.Verified: 05-16-2023
Check Valve#1 Check Valve r2 Relief Valve PVB or SVB
X Closed tight at X Closed tight at X opened it. 2.6 Air inlet opened at psi
ge 7.0 psi 2.5 psi lbs reduced pressure Did not open
4.
Check‘1.11ve held at psi
Leaked Leaked Did not open
leaked
T., cleaned only cleaned only cleaned only cleaned only
Replaced:Replaced:Replaced: Replaced:
rubber kit rubber kit RV rubber kit rubber kit
CV assembly CV assembly ltv assembly CV assembly
or or or disc,air inlet
disc disc 1 disc disc.CV
014
0-rings 0-rings diaphram(s) seat (A.
61. Seat Seat seat spring.air inlet
124 spring spring spring
sprint.CV
stemlguide stemiguide guide retainer
retainer retainer 0-rings guide
lock nuts lock nuts Other 0-rings
Other Other Other
Closed tight at Closed tight at Opened at Air Inlet psi
psi Psi Check valve psi
IL.
Remarks: Installed by others
I certify that the data in this report is accurate:
Tester name: Matthew Smith TesterSignaturt 7 /,,,..e..;;-:-:
7' Date: 06-14-23
Affiliation: Cert 4 J02-23-10852 Phone No: 904-268-8009
Tester 42 name: Tester Signature Date:
Affiliation: Ceti 4 Plinne No:
Tester Company: Addr.
This assembly: X Passed Failed