10-25-2022-03-29-40-PM-USCG-Sitka-611-Airport-Road-Back-Flow.pdf
PDF 301 KB Posted
- Solicitation number
- 70Z04524QKODI0019
About this file
This solicitation is for annual backflow prevention system inspection services. The U.S. Coast Guard is seeking quotes for inspection of backflow prevention systems at the USCG Air Station Sitka located at 611 Airport Road in Sitka, Alaska. Quotes are due no later than 1:00pm Alaska Time on January 17, 2024 and shall be submitted to the contracting officer via email. The inspection services shall be completed by February 15, 2024. This acquisition is set aside exclusively for small businesses. The primary point of contact for questions is the named contracting specialist and work will be performed at the listed Coast Guard air station location.
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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 # 017295 Assembly ID Contact Name Test Due Date Tim Logan
Assembly Location Information Facility Name Location ID USCG Sitka Service Address Zip Phone 611-Airport Road 99835 (907)942-7562
Property Information Mailing Name Same Address 1
City ST Zip Telephone
Assembly Information Type Size Mfr Model RP 3/4 Watts LF909 QT RPZ
Equip Location Club boiler room
Hazard Type Domestic
Water Turn Off Authorization: (Print) Time
03:17:14 PM
Is the Assembly installed in accordance with manufacturers recommendations and/or local codes? Yes No
Test Date 10/25/2022 https://mydoforms.appspot.com/
Initial Test
Pass Fail
Reduced Pressure Principal Assembly Check Valve #1 Check Valve #2 Relief Valve
Held at 8.1 PSID Held at PSID Opened at 3.4 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
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 07143561
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 Steve Sizemore IV 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 723
Customer Email
Other Email
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