09-22-2022-11-37-36-AM-Coast-Guard-Air-Station-Sitka-Mains-shop-boiler-Sitka-Back-Flow.pdf
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- Solicitation number
- 70Z04524QKODI0019
About this file
This document includes a combined synopsis and solicitation for annual backflow prevention system inspection services at the US Coast Guard Air Station in Sitka, Alaska. The solicitation is set aside 100% for small businesses and seeks quotes for inspection and testing of backflow prevention assemblies in accordance with the statement of work by February 15, 2024. Quotes are due by 1pm on January 17, 2024 and are to be submitted to the contracting officer at Jacqueline.L.Robinson@uscg.mil. The place of performance is US Coast Guard Air Station Sitka located at 611 Airport Road in Sitka, Alaska. The estimated value of the contract is less than $10,000.
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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 # 276913 Assembly ID Contact Name Test Due Date Tom Logan 09/19/2022
Assembly Location Information Facility Name Location ID Coast Guard Air Station Sitka Mains shop boiler 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 2” Watts 909 M1qt
Equip Location Maint shop boiler room
Hazard Type Domestic
Water Turn Off Authorization: (Print) Time
11:03:00 AM
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 3.8 PSID Held at PSID Opened at 8.2 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:
Midwest 845 Na
Remarks
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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