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

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. 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. Please also see our 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. 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. Please also see our Privacy Policy.