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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 2140 141st Ave. NW. j Andover Mn.55304 Phone(763)744-6149 OWNER INFORM 5L-I N'(pi l,c,c 1\ PkA A-d Omar Name ` titresAdaeet3 State Zip Cade Oweaet"a Contract Parma Yaklp9 wa liwntha' � ORMAT11J1$ 7 l a'v1 A P 1 •f'1'.••,,7 ( t S - ) a 7 S� 1 k ) Nerta / S et Admaos cif se 00 Aid ;;• uu, e,11 1.4 A K,......:.:,. zi t. o '� _ c AAq 5Arv'' •!?f.v .�Model- EVid—iliu Par-. ; i"ti iPt , , 7C )'' (.. j 9J'/ S .( 1NrnAL TPBT a ht�� ❑Leaked PSID I Did not open Static P810 Static d l� PSID MEALIEST Massed BIM ❑Cbsed tight Opened is P81D Static PSID Static MID (VECTOR BYPASS ASSEMBLY INITIAL TEST � RP Csi M PSID oLeaked ©L M n d Static P810 Static PSID DETECTOR BYPASS ASSEMBLY ANAL TEST tight 0 Closed Opened Stade PSID Static tight PBID b PSID P V P V U FINAL Airin�tsettvlqlva -. , , !rte �1f o ht u L led at pen P81D •R tight 'Opened at MID Staab Para Static P81D COMMENTS ' 3 `'tom`r 5+ I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Name(print) 7)a,h h PI ji ?1-e A Registration No.0 6C3a3 I rTlt#e of Day Taster Signature (tom /1-4.-e4 Phone No.76,3 Date /.-1-7// `I 7c 5/(;/V`) 6T /9 '3DFId S9SS SSL £9L buTgsas aT2qszaqui NV 8S :OT STOZ•8Z•brd Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave.NW. Andover Mn.85304 Phone(163)1444149 OWNER INFORMATIQ� J L' C`\'l l_-Cd A i ) it,' ;,-� cM w Name Al -J/Apws_ �fleyriA4dre e v 7 ' , • /` �,/ *e . J^ •to J• .. ovelerts tented Person Tolep&ione IYunber • AC �AT)0N Street I, Address A 1 Z:fripti .e [ ll LA •1°'�- hfir' if 1 io �' le0i eA i a �' k o„s, -` ,Zip bode cif egoacrialiolifrk Pei,t4 t < 4 L el4Z/t. /2dc As, ,' yin 4,e,k ti A Menem I t i -.r 7 .> i-A seal ?c c Size 3 H1RP D RP r ❑ DC O DC Doctor 0 PVIVIND TEST '.. R ►erf valve . ttattt tight mad at ' Z-- P810 0Leaked F_8. ❑leaked o L- 0 OId not open Stadde P8(0 Stade (�P8(0 C1Ctosed dot C]Coifed tight Opened at• MD Slade PAID Static PSID • DETECTOR BYPASS ASSEMBLY INITIAL TEST MobtrEss �7Cloead light ll t Opened MD O Leaked O Leaked ❑Did not open► Stack PAID Static P81D DETECTOR BYPASS ASSEMBLY FINAL TES ©Closed tight ❑Closed tight Opened at PAID Static ,PSIO Stoic PAID '°T'. °+•;. Agg 71-771711- .r. -3.— . TJT:ITT .. Y • '7'ri".r FINAL •-r... i OpeOe rao pen PD rose :Opened st PAID Closd tight Steak PAID Scotto P310 • COMMENTS r3 r r( Q f ." Lam. —,. I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Name(print) 7)a A 0-1 f 1 ) 1144.. Ragiseration No.06r 3-23 R rilrha of Day Tester Signature (./0'v^.., - Phone N0.743 Data ?-•.a7-1 N` 7c'4.r ;/y 6T /L '2DVd S9CS SSL S9L buTgsaz e e saaqui Yew 6S:Ot StOZ-8Z'- 1