Loading...
HomeMy WebLinkAbout2015-08-27 Cross Connection Control Device Performance Test Reports - Interstate Testing Cross Connection Control Device Performance Test Interstate Testing 2140141st Ave. NW. Andover Mn.68304 Phone(763)7448149 OWNER INFORMA7 .N _ Owner Mane SeaM Addle..A 1 ,--/-:t . 1g gp c i 1± ap Code Duero Oxtteot pan `apnoea Number /�A .t1V 1Nd� lA in P%-.. /�P Pt." y. 4 o ei ( 47 C /) 7 7 C S, ' c ') Warne \ T77 Aczat.,A,.k Sel A tc ______ di a:,4.-e n V GI)/ Lze Weber ' model LA-) (-k 1 h c_ 4, 7 S X'� i /6.744) , Size .. i* 4Laf"'"C1 RP Oftector 0 DC ❑ DC Detector 0 PV®ISVS ... ,i�Ll-�n�AL,EST '�j . 0C$osed Opt Fr.. tight ;•,:..._;'''''..'.111t'''' ,, ',•..,:.at '.' 3 , -� P8ID . t3tatic 8' PS10 Static Old not open Pelo T DCiaead M °Closed tlpt* Opened at _PSID Static PSID Static PSID Imam BYPASS ABSEIABLY INITIAL TUT .. Cloaked VgM tkiht PSID❑ ©pld not open 9a PSID Static, PSID DETECTOR BYPASS ASSEMBLY FINAL TEST _.. •- , 0 Closed dirt D Closed tight Opened at PSID Static P810 Static PS1D Minute VACUUM DitfAlctR ed AL. i Piteeeulle VACUUM IMAM PHIAL TEd t •9itlodtt]em 'AI1e les PSO B ed tight Opened at P9D llq ptt Q Od open Static P810 Mello P8ID • COMMENTS 3 • c-tR9 I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(print) 7)a•1 PZ ill / 11'e h Registration No.06r3-13 R 7—Tlrne of Day Teeter Sire ( a -i friz. -t, Phone No.7(a 3 Date 2 .1.7^/ 7y 6/Y 6T /ST "Z0Vd S9ES SSL E9L butqsaz azegs.zaquI KV 50:TT STOZ-8Z'.6 Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn.68844 Phone(T63)7444149 . OWNER INF, • ,._. ,!.. ' --....'—..-- ' .I •bs.tkMaos • ' i. ii"."T, 0:1.77 . . k 8Veel da 1 ,Zip { , P _ .e /1 Laterf fr././I L J( '7”7 'umber size 2 '' - 0 RP Detector 0 DC ❑ DC Osbector © PVBw® Tow TEST .-- -0 Waked MID °Waked 81s11c P. V P810 Statik 0 '--'P810 ta open ' EINAL ed 0etk P810 Clamed apt* Opened e4 _PS1D $Mc ,PSID OSTECTOR BYPASS AS891BLY INftAI.TEST BEBISIXIbm -gime D11ght CICI tight at �D Stoic MID Static MID CTDR BYPASS ASSEMBLY FINAL TESTT 0 Closed PBiD ❑dosed MDm Opened at P810 Static P81D '''.-7 SSURR Y •- U11 71-7711.:v .. .. .,, PTT.. :, , h 7 ' .1771 i T n TUT Er Did a op 81D �claae tbNt .Opened at P610 t Qo J saa tight Stale_.�...r,, Static _PBID ---�-PBib • COMMENTS I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Nam.(print) fp d,1 rl frt, /j.t a won No.06C3•23 R TIrt,e of Day Tester Signature c�o+� - Phone No.76 3 Data A-.2 7 - ! °i 74eY ;/q' 6T /ST ��Xd S9ES SSL S9L buTgsaI aqr saaqul Ni ZO:TT STOZ•8Z'bmd I /11 Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn. 69304 Phone(163)7444149 O4aYNRR I!l�FORM 1 . M • + ., , , "a 10"•+* .. ,q,- . WWII, d A' It ! 1rl r AP 17-rcAy ( 6c /) 7? c c5? S None cli.t_g-le:_rtz)f___ Manuteaturer Medal Size 141 '' r Tpe D itP Detector 0 DC Q DC Detector Q P BFSVB IRAS.TEST �fpht vrtva at j PQ r PSID Static PSID � Closed tight a Closed light Opened at PSID Static MID P310 ONTECTOR BYPASS ASSEMEILY INITIAL TIiST y. Il�SgN CI tasked Statie MO Stalk PSID —- e DETECTOR BYPASS ASSEMBLY RNAL TEST a Closed tight SCI Diosed tight tatic PROD Stela PSID Opened as PSID HOW*YACalu'ISREAKER INITIAL.no' ologt!— VACUUM Mom*p1NAL MST�p� O,erwd atat P810 Cbaod IIgM :opened et Palo UAosed$ht L IId App U tceeked 8 , Static PEW MO COMMENTS I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(pint) 7)0? n fl 7 t j 1 e a Registration No.04S3a3 $T11 d Day Tester Signature (2o+�. /1 -e- 94, Phone No.743 Date 2-.2i, / 7 c'q;/y9 61 /bT '3D1d S9SS SSL £9L buTgsas aq.EgszaquI WK ZO=TT STOZ'8Z'btW I