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HomeMy WebLinkAbout2015-08-27 Cross Connection Control Device Performance Test Reports - Interstate Testing . /As ; Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave.NW. Andover Mn.9304 Phone(763)7444149 OWNER INF . . 6510 5 ,Cam('cu s.h I k',A-'G_` Oanur Manta �l a threat Adidas I%., itia190010 IOW 1FAMTTINCO1 ► 9f Gb-out Mdreee s e a e' / �" 0 0 a A P. , ' . pi. "� I-)ti A f ‹. r � 11Poanu a 7 A '' . 9erbd t�ivinDer � � � �. .7 75 ,X' 4— 90 2 -7 j '." 3 g w__m g ' hbc`t.,„ flap— rRP ' ❑ DC ❑ Its Minim Q Pvespe Masked ti0M J ;, P810 • Old not open Btattr: 1 P810 Static O V PSIO C*aeed lot* C3 Closed tight Opened At P510 8bsllc P810 Static. P810 ODTECTOR BYPASS ASSEMBLY INITIAL TUT BE revs Closed t O at P3t0 ❑Leaked Leaked `.,vim'not open Sado PSIO Static P810 DETECTOR BYPASS ASSEMBLY PMiAL TEST ❑Closed tight 0 Closed tight Opened at P810 Static P8I0 Sfatlo, P4340 vACt1UY BREAKER T ' PRESSURE VACUUM BREAKER FINAL MST Air INst vetre gp p810 Clod tight Opened at--MD UC M PStD L7 Db Aot apes ©united P810 • • COMME 1T8 • Jf ‘1,04....- : - I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTS BY ME PERSONALLY. Teeter Name(print) ID a vt 9-1 ill , 114 i . Registration No.U6S3- 3 3'i Tina of Day Teeter signature C!a"`'k frt.-'-- -c Phone No.7"3 Data e-02-7- / K 6T /Z •aova S9CS SSL S9L buzqsay 91Egs-zalul WV LS:OT STOZ • 8Z•brV Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn.56304 Phone(768)7448149 -- 70 N(fiv\r,c)-) t c'OWNER Air t i 0MNtsr N fitrset . . W4 41 e ( di )). ' , r '-, 1 m. M rest AdAteoe 0gJt 44C 1l'e�jAf < tOMIEN11111111111.111 Maid If TIAL TEST nd l raNe� Iva 0�C�� �ed ? ‹ P810 Leaked &aU Closed sot .. R Q Leaked 0 not*pen Static PSID Static P810 ' ANAL 11367 OCbeed•YgN ❑Closed tight Opened at P810 Static P310 t c P810 DETECTOR BYPASS ASSEMBLY INMAL TEST • BEriabitfit CClo � esd tight Cbsed fight Opened at PSID a Leaked ❑Leaked 0 Did not open Static MD Stade PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed tight 0 Closed light Opened at PSID Static P810 Static PS10 PRISSUR1f VACUUItivdrmet mew.tea -PRESSURE VACUUM WEAKER FINAL TEST •. . . i_r ION vaMs ��M U 01 P810 I tight Opened at P910 Ste o P810 l❑7Otd At+l open Static P810 • • COMMENTS • - T 3 --A- ti I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED me ME PERSONALLY. Teeter Noma(print) 1)d%1 et 111 Li/42.r Registration Na 06s3-23 8 TTinte of Day Tester signature C9colietok. "tee " Phone No.7G 3 Data ?•_2 7 "1 C 79'Y6ty9 61 /E '39Vd 59ES SSL 89L buT4s9l a eqs.zaquI KV Ls:O1 STOZ.8Z%OnV ■ Cross Connection Control Device Performance Test Interstate Testing , 2140 141st Ave. NW. Andover Mn. 66344 Phone(763)7444148 1 OWNER INF , , �--- !6T) v'C I' k �J(yeerName 1 _41Q r ,e_ ../) i // 8th 2ip Cod* Own•rs Contaa Person Tei.phcruv Maribor 7 I A v` 5f1,r•.-11 ( 6C ) ) ? 7i- ¶ ? ?3 FAC1a4tY INttORMATION Mme amid/mess c • d ti ... 00 Art . w A : 1..::3, 0 cif tz P�-k 1�4,,F �. Mown* n . . 0 a ' /'!'tq, 4 P MOda aortal Meteor b 0 DC D DC Detector 0 PV013118 171AL TEST id=VW o tight BEIS lei . . f PSC Did not Leaked 8tatln 7-' MID Static t� PSID ORAL MST 4 0 Closedight D Closed tight Opened at PSID Stalk MID Static PSID OATICT0R BYPASS ASIMIABLY INITIAL TEST CIPahrbed light teed at MID Static P810 Static L.J Did t�Ot ope�t PSID DETECTOR ASS ASSEMBLY FINAL TEST 0 Closed tight 0 Owed dent Opened PSID Melia _ P8(0 Stiatlo at PSID PReese kt VACUUM TPA ' P�VACUUM T �P810 L ht .Opea t PSID .d tgM 4aop Looked ale Static P3tD PS10 COMMENTS 3r- l.Q 4�1. . I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(print) 7)o AI n 11'I l 11 le s, Registration No.06r3 2 3 R 7-Tlrne or Day Tester SPgnaPUre C 9erl'+.. _ �� Phone No.763 Date 2-,Z'?- /� 74/5/ 4/1/9 6T / ' *ao lcia S9ES SSL S9L but saz ageqs.zaquI NV 8S:OT STOZ-8Z'bnv