HomeMy WebLinkAboutBackflow Pevention Assembly Test Report - Inspection - 800 WAVERLY ROAD 4/23/2020 CI T"AS FIRE PROTECTION
CINTA60 o NARRA ANSETT PARK DR
READY FOR THE WORKDAY TV
PAWTUCKET, R1 02861
USA
02861
Backflow Prevention Assembly Test Report
customer: A WALL EENS 10209
Property Name: NA WALGREENS 10209
Address of Property; 800 WAVERLEY RD NORTH AND OVER, MA 018455047
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Type of D : D Double Cheek Assembly Latl.........
rlserbly; prinkir room
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Mfr.: Amesdel: Colt 0OD N: F 1141 Size: "
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Type of Protection; Containment Type of Service: Firel i e
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Assembly orientation; Vertical State of ba l flow before test: On oming Line Pressure psi: 110 3
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Check Valve #1 Check Valve #2 Shut off ##1 Shut Off ## s
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Closed.Tight
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Check Valve ##1 Check Valve #2 Shut off#1 Shut off# v...:.�
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Test Completed: State of bac[ flow after test: On Test Results: Pass
10000
Comments: None
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Test for: New install Replacement- OLD # Existing Device
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I fr: Gage It x 1 del: T# ,0 : 174216 glib, Date: , - 0
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have completed the above test and hereby certify this B ckflow Prevention Assembly performed satisfactorily and
meets Federal State and local codes and regulations as required.
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