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HomeMy WebLinkAbout2015-08-27 Cross Connection Control Device Performance Test Reports - Interstate Testing Cross Connection Control Device Performance Test Interstate Testing 2/40 1414 Ave. NW. Andover Mn. 58304 Phone(TS3)7444149 OWNER INFO ...T,•,, 15 51 3 c-� ' 1 J-1 --"\( • mg FORMA`ION S S c�c Street Address 7:Lei-“Pe Li Lit A 4' t Ale-\ Cow AAsnur �v if)1+a ;s AN. R GC+vy if Al�tP t— )�4 r r- Mood UM Number 9t= 34 AseemblY TI Pe $$P Cl RP Detector 0 DC 0 DC Detector 0 PVB/$VB NmIM.TEST tippt ,;, .:. • - nraye 0Leaked •taisi edHpht •,, • at p r PSIb Static ' '° P81D Static 0 • Did not opus PSID ONAL Static e °Closed tight PS1D gem PSID � P81D Tema BYPASS IMAI14.Y BKrCMLTEST arra>09 S tatic _,,,_ROD 0 Leaked Static �.►Oki not open PSID 0 BYPASS MISEMBLY FINAL TOT Static PS10 Sllc t6M PAD O e AND /4 1 0 11101t8 v A c u u M M MIAMI l .liter ' PF etu*E',Amami a❑ n ca PSIO Closed tight t Pep 1 Pt I aaked Stade Static PSID NM COMMENTS '^ c72 h� 54- I HEREBY CERTIFY THE TEST REMUS.ARE TRUE AND THE TEST WAS BY ME PERSONALLY. Teeter Name(print) c` ■,‘ _ . J� / / -L ti Registration No 81s6s.D.3 Time of Day Tester signature Z ` Phone No (763) 7444149 Date R- 3--- 6T /TT 3��Id S9£S SSL £9L buzgsay agvgsaaqul NV TO:TT STOZ'8Z 'bnd Cross Connection Control Device Performance Test 1 Interstate Testing 2140141st Ave. NW. Andover Mn.66304 Phone(763)744-6149 OWNER INFORJIA'fIDN ----�-- '_.f 1..S h 7"/--tikic" Pi •� eh e * Ownees«. ,., Penn TiMpho:w Number .T> >^• "9rivti r �� ( / - , ) 7'7 s' 5-,i c3 • .'.0-wef 6.1 - nacoa� c7c c ' Si. iV0 _ tr - A►. ,' ■-C t- ' 1 I i-► Moos) 81E0 . l/Type 4 RP D RP Detector ❑ DC © DC Detector CI PvB/B9/B Tim.TEST M irldriont Mooked r ∎ tight t at 3 4 PBID Stack l . ' P810 Ste* L i 01d not open P810 amtseey Qctoeedd t* ❑Cios ed Eght Opened at Static P81D Stalk MID riDETECTOR mass ASSEMBLY nwnAt,TE$r 0 tat ■ eld rilt"o and tight P841) Static MID 8th PSID u Old notopen DETECTOR BYPASS ASSEMBLY FINAL 159T Ste P810 Sa0e P51D a PBib PRhtsURL YACtraWratit IN ttAL nit t v Old aot open •tasked 8 G�ht 8eatla _______.,P810 Mete PSID COMME( e --_+ - o S4 I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED SY ME PERSONALLY. Tenter Name(prink) Dann Al L p h.0► Registration No.065'3.33 R 7~ Time of Day Teeter Signature (91-wuN. L W Phone No.7(,,i. Date 7WI6/i 'j 6T /OT =km S9SS SSL £9L but�.saI ag-egsaaqul NV 00=TT STOZ'8Z'b ' Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn. 58304 Phone(7 63)7444149 OWNER INFO-.,..;,T , lie; $11,14,e_e_,.t_..... X41 p.,...1.0e%p cads Owlet's Contact Person Hamper F INFORMATION T► K^.. A°- S ° t , t 6 C ! 7 cf!'f'� F.4141/41,,Zan;c4)4 f� 4 Street A drse 1 1 Ld A ( owe / 3 c 7 c S F'1� s 9- Az:41-4 Ate ip. fc --- Le,�eg. hefty/. Manufectrst r_ )(L/C 044%.C e► h'C. 7 S›c4-- ' Serial Number Mai Aeselinbly Type P D RP Detector ❑ DC ❑ DC Dior ❑ PVM/gvg IN,TLffiAit ,tET teed gOht ° ,`diced G, `� ❑ tint ref 3 y Psro P810 Statla <S Pa1D `r gIn not open NW OCIesed dips 0 awed tight Static PSID 9tiaur: PSID Opened at PSID • OTTE"--------------------------------------------CTOR BYPASS AMIABLY INITIAL 11EST ICJ dosed tlprrt O,yam stink MID S ❑Oid npt own PSID PSrD DE CTOR BYPASS ASSISIdLyFINAL.1E9T ❑Closed tight S Ic PSID CI Closed t Opened M PSID Stalk .PSID PRESSURE AMUR i V FINAL TES M_______•_,Ps10 Gosod -OpeIe �mtim CId not open s Leaked�M -Opened at PSID C]C;10 t1t Static PSID e . P231() COMMEIiITB 1 HEREBY CERTIFY THE TEST REISULT5 ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY, '- Registration NO. , ' . /Thee or Day Tester Signature , Phone Flo. (763) 7444149 Dabs ,?.....17) c"-- 6T /6 '39Zid 99ES SSL £9L buz�,sal, aTe4s.zaluI NY 00:TT 5T0Z'8Z'bnK Crass Connection Control Device Performance Test Interstate Testing 2140141e1 Ave.NW. Andover Mn.36304 Phone(T03)7448148 DWNER lNF T N /,tar Z "-ig �� I+.y"l�� St t e 214)code CJwnefa Contact Ps, Temp nejv ansor RAC!U n INFORMATION `'"► /� M S'¢'rc As- (6�1 77 2?S 5 Irwr .. .- �e I ho4 / ham° c---, c a>'� S r NG..co.q CN ►4~'� Pe ,fis r Manufacturer L0�e,- Ai.<<A R� 1 rr►SS-f- ha `A. Mee Y4-- GSA (a 1 /2- Assembhf Type n RP Detector 0 DC ❑ DC Deteceor ❑ PvB18vs TIM.TEST lilLealtSdc PSID p- Psro ked Static O 9-= PSID Od not open P810 MAL VEST °Obese*gig 0 Goad tight Opened�� StatIc PSID M MID OFTECTOR BYPASS ASSIMSi.v MAL Tt t;leeed tight Rp 1fd$it vain_a_ fJ Masked `+ � Ones at Pip Looked�� P810 Static PSID PS►D ID Did not open DETECTOR MYPAS8 C3 Closed ASI SMBLY FINAL TEST tight St oaad Static Closed tight Opened at PSID P310 Static PSID 'r RE VACUUM eiNtAittn INtfiAt.MST FRgegUgis VACUUM�AKBR INAL TEST 6(r inipt a , A. e `��1 ed at P810 a 1t ht :Opened at MID QCloeeif We Static PSID --- PSID COMMENTS --..— 2 t --(-4,1,- Tad:1-- I HEREBY CERTIFY THE TEST RE ULT$ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Name(print) pc.,rN ki► 1 tei- Registration No. Ji re 6(3,1 Time of Day Tester Signature C9,7,... el ^'2 Phone No. (763) 7444148 Data t, i `-/ 6T /8 'aolid S9�5 S5L £9L butgsas ale sza�ul WV 65=0T STOZ'8Z'b d Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave, NW. Andover Mn.18304 Phone(763)7446149 OWNER INFO MAT.e_ _ _ .. NeensN�e ' �8 to Zp Code try Confect goon FAcniTY��al �►�eaMe :T1m AP 7f4py ( ,SI) 77f cg 9 Fumy Nern• s?' Al 416 s . '- s 41'69 Al i 144 1 n i , m°'°°` , 7 4C Xn4- ;30,2-, Y(7/0 e.eP-' n RP Detector 0 DC u DC Detector 0 P . ifrAL TEST hittregtt 1.J itallNd apt r [?0 Leaked 8 ® P810 °teerced �..� 3Wtle P810 -0 P81D y__ 8tatic P81D Static �� D Opened s�• PSib , PSID BYPASS ASSEMBLY eanAL TEST Cirred dm > Leaked P81D 0 Lek> U Oened et 01d not open PSID Static P8ID ❑ BYPASS ASSEMBLY FINAL TEST oCaned ❑posed tight Opened at P810 Stela P8ID MID Pftelione VACUUM P V Akkiebteiye !!�+n Pero • . NAM i-'lend aspen i Leaked ®t P81D Cl Cbaed apt-�.,_,_MD ..,�._PSIO COMMENT8 ��" `" . ....- /� - �._..... I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTEDJY ME PERSONALLY. Teeter Name(print) Do"I PI fil , /be a Rsostni Jon No.04 c3-13 R rvirne of Day Tester Signature t!27,•..‘ `e"' Phone No.741 Date 6.3—�.7—/ 7YY 61 q9 61 /ZT '39'dd S9£S SSL £9L butgsay agagsaaquI is TO:TT STOZ'8Z'b d