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Home My WebLink AboutSafeway Fire and Back Flow Test - COM Inspections - 12/1/1998 Yy,o, v�a••r2.4.n'{k 'L.:, •4'.v r, {i5`y'S•: .F.. C :::.�::...::::.::::.:..:�::•::2...•:+'•:�:::....., .. .S`k..:.. ..) .',o,N: ,..:>... ,.....'X.,•Y.2�.:t.4::..,...1...h•::..,.X:'r?•Y'•11` +4'r,:•J:::: ...:?.... }}•�:: >:;::::;''c2>':1: ;:;?{:r11T:•a:•Y.;..Y:;}:.:..;..#„•r.�.5 :.,+,-••g.�x,. 9 ��f:x� ::•;x;:?qj;.: .};G•`:`#.�: 12.;:;}. .„/,... Kv t:.:3:Yi+Yn .k.v}1 i��2::2n•}:v: } r.i....:. ry;b.}••:C}'r �$.. .4 .{.Jr.4}+ft v�.'�iS:' .ti •>Y:.asY}:•:;:..•ai•Y:.sTT:?a::.:!.::3,.?•:::::::::.....fa:...+e:. .,+':.•d!r.:... +}:' .. . . ..:.:Y:�s.• '• C a '..r:. R. �}...;.t.�:::.,1....hY.ti........:1��•:?•r'r::'•:?:..:,•:,.a1 k ::.{.:.....::.v.::::::::::.:.•, is :?:+�. ::........::::::.;., 'f..a xx.:•.i•::?w::?•:::r:.x•.:o}.:{:{.. •.+•.,.WEI ;,::}..::`.:..f}..T....t. !>:i.;:%;:;•;::.:::::.Y:.?�:>:.?;;;.; NAME e31C MANUFACTURER OG�� MODEL SERIAL NO. ��-�� DATE f J TEST VERIFICATION This will certify that on the above date,Duke Products performed a leak test at 100+psi pressure and/or water bubble test. Checked the calibration+/-2 psid(per 9th edition of the USC-Manual of Cross-Connection Control), by reference gauge and/or water column. 100 PSI FOR 10 SECONDS. LEAKAGE 1! / PSI. .::::.;,•::.;•:::::::.r::•?;:,.::..}•::.:.i.}:.:::.},:.;•:..:<:.::.a1::.1Y:••i:•{:.::;:.}}:a:n.:,,:<::::::,<..i'.Ta•:::.::;.a:.:.T�x?•}:«<:::YY:i.:;?.;Ti:.i:.i::4:::::;??.1:<41:.;:<.:2.:.;:.;:. 1.0 PSID ACTUAL PSID. 2.0 PSID is 2du!P PSID. 3.0 PSID. c PSID. _;: . .. ..;:. - ,a.:;,.::...:.;::1:.;.::?....::..:1:;a?;;:;y:1::-.T:::.x:•S:t.ra:::::.:::.:aSTr2:;:;.:..;:?.Y:•.:•;•}:•::.;<'T\:<.a:.,�.�:;.:.•:.a':::.Y:;:x,:::::;:.::::;,:::::.:::- HS- 100.0 PSI LS-98.0 PSI DIFFERENTIAL = 2.0 PSID. ACTUAL PSID. HS- 100.0 PSI LS-92.0 PSI DIFFERENTIAL= 8.0 PSID 11 ` PSID. ACCURACY: +/-.2 psid(Ref Manual of Cross-Connection Control Ninth Edition) COMMENTS: SIGNED :ir:;.;;:;i.Y:?;.}:.: . >:.:i.1.}:.1:.::::1:.1;:.: 4:;.:::.:•}:.1:.:.;:«.1/:.:?.;a:.: a1>:.;:.;;;:.;::.S;:.Y;>;;:.;::<;<:;;:.::::.;: ; szE >�'RO'�X. C' >;};>:;.�'" 0�� •0 :::� Q'.;. ;:...�R.....�N�i..C.�...�,3.��i�:;>:-;;:�.4..��"�5►.�. .'kQ CALIBR AT/O.96 ............................ ACE PAVING COMPANY, ry - Backflow Assembly Test Repo L= 1•J•J 1 Name of Premises Safeway v r° R Y,A re• Service Address Belfair Hwy I° ' �I�S!T Ey r Location of Device In south vault,NW corner of store. Device Febco 856 8" 9810261445 Manufacturer Model Size Serial No. Line pressure at time of test 90.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DCDA 1. Leaked .......... 1. Leaked .......... 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... X 2.1 psi 12 psi 2. Did not open .......... Cleaned .............. Cleaned .............. Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper............ Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphram......... Diaphram......... Other(Describe): Other(Describe): Closed .......... Closed .......... Opened at psi psi psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturer/Model Serial No. Calibration Date The Above Report is Certified to be True: Initial Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Repaired By: Date Final Test Performed By: Cert No. Date Signature ACE PAVING COMPANY, INC. Backflow Assembly Test Report Name of Premises Safeway Service Address Belfair Hwy Location of Device In south vault,NW comer of store.Bypass device. Device Febco 805YB 3/4" A008936 Manufacturer Model Size Serial No. Line pressure at time of test 90.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DC VA 1. Leaked .......... 1. Leaked .......... 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... X 2.0 psi 1.8 psi 2. Did not open ............. Cleaned .............. Cleaned .............. Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper............ Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphr.......... Diaphram......... Other(Describe): Other(Describe): Closed .......... Closed .......... Opened at psi psi psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturer'Model Serial No. Calibration Date The Above Report is Certified to be True.- Initial Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Repaired By: Date Final Test Performed By: Cert No. Date Signature ACE PAVING COMPANY, INC. Backflow Assembly Test Report M p Name of Premises Safeway — S 1}O Service Address Belfair Hwy Location of Device In north vault,NW comer of store. Device Febco 856 4" 9906251323 Manufacturer Model Size Serial No. Line pressure at time of test 88.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DCDA 1. Leaked .......... 1. Leaked .......... 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... X 1.9 psi 1.6 psi 2. Did not open ............. Cleaned .............. Cleaned .............. Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper............ Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphram......... Diaphram......... Other(Describe): Other(Describe): Closed .......... Closed .......... Opened at psi psi psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturerlmodel Serial No. Calibration Date The Above Report is Certified to be True: Initial Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Repaired By. Date Final Test Performed By: Cert No. Date Signature ACE PAVING COMPANY, INC. Backflow Assembly Test Report q a Name of Premises Safeway H6 f0 Service Address Belfair Hwy Location of Device In north vault,NW corner of store.Bypass device. Device Febco 805YB 3/4" A011302 Manufacturer Model Size Serial No. Line pressure at time of test 88.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DCVA 1. Leaked .......... 1. Leaked .......... 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... X 1.8 psi 1.4 psi 2. Did not open ............. Cleaned .............. Cleaned .............. Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper............ Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphram......... Diaphram......... Other(Describe): Other(Describe): Closed .......... Closed .......... Opened at psi psi psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturer/Model Serial No. Calibration Date The Above Report is Certified to be True: Initial Test Performed By: Skip Beahm Cert No. B 1791 Date September 27,1999 Repaired By: Date Final Test Performed By: Cert No. Date Signature ACE PAVING COMPANY, INC. Backflow Assembly Test Report Name of Premises Safeway — Service Address Belfair Hwy Location of Device In middle vault,NW corner of store. Device Febco 856 4" 9903261433 Manufacturer Model Size Serial No. Line pressure at time of test 89.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DCDA 1. Leaked .......... 1. Leaked .......... 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... X 1.8 psi 1.9 psi 2. Did not open ............. Cleaned .............. Cleaned .............. Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphram......... Diaphram......... Other(Describe): Other(Describe): Closed .......... Closed .......... Opened at psi psi psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturer/Model Serial No. Calibration Date The Above Report is Certified to be True. Initial Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Repaired By: Date Final Test Performed By: Cert No. Date Signature ACE PAVING COMPANY, INC. Backflow Assembly Test Report Name of Premises Safeway Service Address Belfair Hwy Location of Device In middle vault,NW corner of store.Bypass device. Device Febeo 805YB 3/4" A010238 Manufacturer Mould Size Serial No. Line pressure at time of test 88.0 lbs. Pressure drop across first check valve N/A lbs. Type of Device DCVA 1. Leaked .......... 1. Leaked .......... X 1. Opened at N/A psi 2. Closed .......... X 2. Closed .......... 1.6 psi psi 2. Did not open ............. Cleaned ..............X Cleaned ..............X Cleaned .............. Replaced: Replaced: Replaced: Disc............... Disc............... Disc,Upper............ Spring............. Spring............. Disc,Lower............ Guide.............. Guide.............. Spring................... Pin Retainer....... Pin Retainer....... Diaphram................ Hinge Pin.......... Hinge Pin.......... Spacer................... Seat................ Seat................ Other(Describe): Diaphram......... Diaphram......... Other(Describe): Other(Describe): Closed .......... X Closed .......... X Opened at N/A psi 1.5 psi 1.1 psi Comments: Device passed test. Test Equipment: Duke Model 900 981201 December-98 Manufacturer/Model Serial No. Calibration Date The Above Report is Certified to be True. Initial Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Repaired By: Skip Beahm Date September 27,1999 Final Test Performed By: Skip Beahm Cert No. B1791 Date September 27,1999 Signature BELFAIR WATER DISTRICT# 1 P.O. BOX 563 BELFAMWASHINGTON 98528 ♦ (360)275-3008 FAX : (360)275-6410 September 1, 1999 TO:Ace Paving Company Inc. P.O. Box 4100 Wycoff Station Bremerton,WA 98312 RE:Flushing of Fire Lines On tuesday August 3, 1999,I Thomas Crosswhite at the Belfair Plaza, Safeway Store witnessed the Flushing of the Fire Lines. Thomas Crosswhite Date r ED SEP 16 19,ca PERMIT ASSISTANCE CENTER MASON COUNTY FIRE MARSHAL Mason County Bldg. III 426 W.Cedar Q P.O.Box 186 Shelton,Washington 98584 (360)427-%70 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION AUTOMATIC FIRE ALARM SYSTEM ACCEPTANCE TEST REPORT TEST DATE 4122/(9U L & I INSPECTION DATE ADDRESS 9 S�. 3 FIRE DISTRICT Z--- I OCCUPANT 5 V 14 PHONE USE FIRE ALARM CONTRACTOR C cl e ►tidCS- PERMIT# I CONTACT PHONE i CONTROL PANEL MODEL# i I CENTRAL STATION PHONE 1-960 76 — 6 ACCT# ¢O0046/ PHONE LINE NUMBERS: #1 �S -l/. 4 #2 ? 5 - 1 I DESCRIBE SYSTEM # ZONES C� DEFINE ZONES z� to sft 4 l I E yam,, i