Attachment 9_Back-flow Valves Test and Maintenance Report.pdf

This document is a Test and Maintenance Report form designed to document detailed inspection and maintenance procedures for valve assemblies and related components. The form provides comprehensive checkboxes and fields to record technical details about valve performance, including check valves, relief valves, and pressure vacuum breakers. Key sections allow technicians to document valve condition (leaked or closed tight), gauge pressures, replacement of components (such as rubber kits, CV assemblies, discs, O-rings, seals, springs), and overall assembly test results. The form includes spaces for customer information, assembly type, manufacturer, model, serial number, and calibration date. A notable requirement is that all repairs must be completed within five (5) working days, and the form concludes with a certification section where the tester can mark whether the assembly has passed or failed inspection.