2321 Mayport BACKFLOW TEST BACKFLOW ASSEMBLY TEST REPORT
Customer Account Number: F— SCAN# Meter# F47059321
Customer Name: Customer Contact:
FD*Ilar Tr"
Service Address: Mailing Address:
12321 Mayport Rd.
city State city State
I — F-
I Atlantic Beach [Florida
I
...............
Zip !32233 Commercial/Residential kornmercial-Annual Test
4068544 XL. _d
Serial Number Mf-CL [W lk7in=s _Mo-ei No. 975 X11-2 51= 3/4"
D Fx- D C RP DCDA RPDA Service Fire Dector By Pass
Location: Water Utility Co. City of Atlantic Beach
Check Valve#I Diff/Prsre RelieNalve Check Valve#2 Prsre Vac Break
Closed Tight at Opened at Closed Tight at Air Inlet opened at
F,—.0 P.S.1 LBS. 1*1.0 P.S.1 P.S.1.
Did not Open
F Leaked Did not Open Leaked
Final Check Valve# I Relief Valve Final Check Valve#2 Closed Tight at
LBS P.S.] P.S.L
P.S.1
Remarks:
Test Equipment Test Results Pass/Tagged
Tech Name Affilialtion Certification Test Date
15
Initial By: !Ed Stokely H20 Backflo,Inc. FsTS398
Repaired By-
Final by:
Final Test Results
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE jEdward G Stokely
(Signature)
BACKFLOW ASSEMBLY TEST REPORT
4:ustomer Account Number: SCAN Meter#
Customer Contact:
Customer Name: ................................
.DollarTree
Service Address: Mailing Address:
23211 Mayport Rd. State city State
',Florida
,Atlantic Beach
..........-----------
Zip 3223-3 Commercial/Residential iCommercial-Annual Test
Model Ng. 975 XL2 Size
Serial Nmmber 14005726 MfQ-' lWilkins
Device Type� DC RP DCDA — RPDA Service Type�Commerical-Irrigation
LqcatLoq: ....... Water Utility Co. City of Atlantic Beach
Check Valve# 1 Diff/Prsre ReliefValve Check Valve#2 Prsre Vac Break
Closed Tight at Opened at Closed Tight at Air Inlet opened at
P.S.1.
LBS. 73. P-S-1
9,0
Leaked Did not Open Leaked Did not Open
Final Check Valve# 1 Relief Valve Final Check Valve#2 Closed Tight at
LBS P.S.1 P�S.I.
P.S.1
Remarks.
------------
Test Equipment Test Results Pass/Tagged
Tech Name Affilialtion Certification Test Date
.....................
.......... 07/06/2015
Initial By: Ed Stokely 11-1120 Backflo,Inc. iBT5398
........ ------
Repaired By
.......................
Final by:
Final Test Results
jEdward G Stokely
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE
(Signature)
BACKFLOW ASSEMBLY TEST REPORT
customer Account Number. SCAN..j Meter#
Customer Name: Customer Contact:
Dollar Tree F
Service Address: Mailing Address:
r2321 Mayport Rd. State
city State city
FFIoricla
lAtlantic Beach
ial A I Test
Zip F32233 Commerciai/ResidentialFCommercial- nnualT
MW Wilkin=s ModeiNg. F975XI-2
Serial Number [Z�7�213 F Size
Device Type: f— DC rx- R P F- DCDA F- RPDA aaNke Tygg commercial-Domestic
F
Water Utility Co. FCity of Atlantic Beach
Locatign:
Check Valve#I Diff/Prsre ReliefValve Check Valve#2 Prsre Vac Break
Closed Tight at Opened at Closed Tight at Air Inlet opened at
F9- [3— - P.S.1 F— P�
P.S.1 .2 LBS. F3.5
7 Did not Open
Leaked F- Did not Open F- Leaked
Final Check Valve#1 Relief Valve Final Check Valve#2 Closed Tight at
F— — LBS F— P.S.1 P.S.1,
P.S.,
Remarks:
Test Equipment Mid-West 845-5 5#U/Ut5U-5b i Test Results FPass/Taggc;
Tech Name Affillaltion Certification Test Date
07/06/2015
F
Initial By: I Ed Stokely IH20 Backflo,Inc. FBTS39s
Repaired By: F- F-
Final by: jF F- F-
Final Test Results
Edward G Stokely
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE
(Signature)
BACKFLOW ASSEMBLY TEST REPORT
Customer Account Number: SCAN# Meter#
Customer Name: Customer Contact:
.............
-Dollar Tree
Service Address: Mailing Address;
------------
2321 Mayport Rd.
City State city State
Atlantic Beach 'Florida
-----------
Zip '32233 Commercial/Residential jCommercial-Annual Test
Serial Numbgr Model No. Size 6"
IY1 0793 Mf(.:L lWilkins j1375 ADA
__..............
Device Type� DC RP _5� DCDA RPDA Service Type�Commerical-Fire
................
L0_Q?A_,o0_ Water Utility Co. City of Atlantic Beach
Check Valve# I Diff/Prsre ReliefValve Check Valve#2 Prsre Vac Break
Closed Tight at Opened at Closed Tight at Air Inlet opened at
P.S.1 P.S.1 P.S.1-
1.0 LBS. 1.0
Leaked Did not Open Leaked Did not Open
inal Check Valve# 1 Relief Valve Final Check Valve 2 Closed Tight at
P.S.1 LBS P.S.1 P.S.I.
Remarks: ........ ---------
Test Equipment Mid-West 845-5 S#07080553 Test Results �Passfragged
Tech Name Affilialtion Certification Test Date
.......... ..................
..............................
Initial By: Ed Stokely Backffo,Inc. !BT5398 07/06/2015
Repaired By:
............ ....................
Final by-
Final Test Results
HEREBY CERTIFY THAT THIS DATA IS ACCURATE Edward G Stokely
(Signature)