09-22-2022-11-34-15-AM-Coast-Guard-Air-Station-Sitka-Galley-boiler-rm-Sitka-Back-Flow.pdf
PDF 289 KB Posted
- Solicitation number
- 70Z04524QKODI0019
About this file
This combined synopsis and solicitation requests quotes for annual backflow prevention system inspection services at the U.S. Coast Guard Air Station Sitka in Alaska. The solicitation seeks inspection in accordance with the attached statement of work to be completed by February 15, 2024. Quotes are due at the U.S. Coast Guard Base Kodiak by 1:00 PM on January 17, 2024 and shall be submitted electronically to the contracting specialist's email. The acquisition is set aside 100% for small businesses with a size standard of $19 million. The place of performance is the U.S. Coast Guard Air Station Sitka located at 611 Airport Road in Sitka, Alaska. The contracting office is the U.S. Coast Guard Base Kodiak. The solicitation number is 70Z04524QKODI0019 and is issued by the Department of Homeland Security's U.S. Coast Guard.
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Text version
Back Flow Form
Anchorage Water & Wastewater Utility Attn: Field Services 3000 Arctic Blvd. Anchorage, AK 99503-3813 Phone: (907) 564-2762
FAX: (907)786-5001
EMAIL: awwufieldservices@awwu.blz
Service Type
Existing New Replacement
Replaces SN# Serial Number MOA # 027504 Assembly ID Contact Name Test Due Date Tom Logan 09/19/2022
Assembly Location Information Facility Name Location ID Coast Guard Air Station Sitka Galley boiler rm Service Address Zip Phone Sitka 99835 (907)942-7562
Property Information Mailing Name Coast Guard Air Station Sitka Address 1 611 Airport Drive City ST Zip Telephone Sitka Ak 99835
Assembly Information Type Size Mfr Model RP 3/4” Watts LF 909qt
Equip Location Galley boiler room
Hazard Type Domestic
Water Turn Off Authorization: (Print) Time
12:14:00 PM
Is the Assembly installed in accordance with manufacturers recommendations and/or local codes? Yes No
Test Date 09/19/2022 https://mydoforms.appspot.com/
Initial Test
Pass Fail
Reduced Pressure Principal Assembly Check Valve #1 Check Valve #2 Relief Valve
Held at 8.9 PSID Held at PSID Opened at 2.6 PSID
Closed Tight Leaked
Closed Tight Leaked
Did Not Open
Pressure Vacuum Breaker Air Inlet Check Valve
Opened at PSID Held at PSID Did Not Open Leaked
Repairs and Materials Used Na
Final Test
Pass
Reduced Pressure Principal Assembly Check Valve #1 Check Valve #2 Relief Valve
Held at PSID Held at PSID Opened at PSID
Closed Tight Closed Tight
Pressure Vacuum Breaker Air Inlet Check Valve
Opened at PSID Held at PSID
Test Gauge Used:
Manufacturer/Model: SN: Calib/Accur Date:
Remarks PVC drain is required to min clearance 1” below drain for inspection and to prevent cross contamination. See pic
Photos
Image 1 Image 2
Image 3 Image 4
Image 5 Image 6
Image 7 Image 8
Image 9 Image 10
Service Restored Yes No
The above is certified to be true at the time of testing Tester Name Company Name Gregory Stevenson North Star Fire Protection, LLC Company Address Phone Number 520 W. 58th Ave. Unit G Anchorage, AK 99518 (907)677-1233 Tester Signature Certified Tester #
BAT 010
Customer Email Tomas.m.logan@uscg.mil
Other Email
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