HomeMy WebLinkAbout2015-08-27 Cross Connection Control Device Performance Test Report - Interstate Testing Cross Connection Control Device Performance Test
interstate Testing
2140 141st Ave. NW.
Andover Mn.66$04
Phone(763)744-6149
OWNER INFOR . . .
owner Nem ■ ` Sheet Address
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Manufacturer Model
Sore 1 Azusai Dh caw 0 RP Detector 0 DC 0 DC Detector 0 B
INf1 AL TEST
E7lsr
iied tight _tight oe� 3 , C'S P810
0 Leaked Static I • 2---- PSID Made a IC PSID U Aid not open
MAL VEST
bsed
❑C M 0 Closed tight Opened at PSID
Static P810 Stalk P81D
OSTIMIOR BYPASS AS3®1BLY INI't1AL TEST
light ❑Cbeed tight Rpppraoisef vat
PSID
. 0 Leaked 0 Leaked U Did not open
Stout P81D Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed tight Opened at PSID
Santo_ PSID Static P81D
PR Ise VACUUMNEAKER INMAL Teitir - I tuRE VAcuuM ERBAKen FINAL TEST
�Q O Ac PSID C iNIMILYINS
o ed tight :Opened at_pap
light
tasked
Static PSID
Static PS1D
•
• COMMENTS ' _z
ar%-\ 1- • 9 4r-
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTEQ BY ME PERSONALLY.
Teeter Name(print) D a%'1 r1 M t 1 ft.,• Registration No.v(S3A 3 8 elms of Day
Teeter Signature C9 -∎ " 1. -- `'4 Phone No.7'(s 3 Date 2—A-7—1 -4-
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