Backflow Prevention Assembly Test Report

Condition of assembly

Type of assembly

psig

 

Reduced Pressure Assemblies

psid

psid

Check valve #2

psid

psid

Inspection of approved air gap

Assembly

 

Double Check Assemblies

Check valve #1

Check valve #2

Assembly

 

Pressure Vacuum Breaker

psid

.

psid

.

Assembly

If an assembly has FAILED, please submit a separate test report after repairs.

 

Submitter Information

Upon submittal of this form, a copy will be sent to email provided for contractor records.

Acknowledgement

Collection and use of your personal information
Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA.  Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at (250) 755-4405, or via email at foi@nanaimo.ca.
Privacy Policy

Last updated: August 13, 2018

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Collection and use of your personal information
Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA.  Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at (250) 755-4405, or via email at foi@nanaimo.ca.
Privacy Policy