HomeMy WebLinkAbout2015-11-05 Interstate Testing RPZ Test Report Nov. 10. 2015 04:17 PM Interstate Testing 763 755 5365 PAGE. 2/ 2
5.;.1' � ::.r Cross Connection Control Device Performance Test
�,�I)rl�,r,
ll-itIsbi Interstate Testing
6
9-6773
2140 141st Ave. NW.
Andover Mn. 66304
Phone(T63)7444149
OWNER INFORM j,*„ . . •
owner Detre Mims
/•
6` 4. •.• OMimor% . ^at •'icon alephols''wmar
FAIN
.1 t. /Zi 4 ,.''C4-< t G 1 I1� 145� ! ( )
Foray Name Skeet Address f he
a t s42-art t,. AttLAL P- 9 #= 4 o c) 't C: c. + (,1 .
Yip Cad, County
msnulackirer Model sol:
Nwnber
�. _ a o fll Pi — A D O 1. 1 0
Size i` Assembly Type ''d D RP Detector 0 DC 0 DC Detector 0 PVB/eve •
INITIAL TEST
.,.•... FP MOO'valve
tight
or'',:':. tight at PSID
SSttadc k� 1 ' PSID Statif 0 ic kext
a (- PSID Old not open
itYML'TEST
°Closed IVO 0 Closed fight Opened at PSID
Static P810 Static PSID
DETECTOR BYPASS ASSIDABLY INITIAL TEST •
L RPmile wivve
❑Closed light Ctoexld tight t'.1ened at PSID
0 Looked 0 Leaked 0 Old not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TENT
0 Closed tight 0 Closed tight Opened at PSID
Static PSID Static PSID
PRESSURE VACUUM 5AIOER I�NTIAL TEST j PP{R�lnlMt ESSU�RLE�
VACUUM BREAKER FINAL TEST
Air Inlet valve t:1. !' ,1Air' IvalveY
Opted et PSID II Closed tight •Opened et, PSID C
Ulose tight
❑Old not open •Lealtiod Static PSID
Stift PSID
• COMMEt1TS V.
fsr 11-a- h4.. cr�,e., 9
I HEREBY CERTIFY THE TEST Repym.ARE TRUE AND THE TEST WAS CONoucTE0 BY ME PERSONALLY.
Tester Name(print) D....,+,. /`i i// Registration No. r3%-04 G 3.23 Time of Day
Tester Signature ( .,9 Phone No. 74 Dote (/- S -1 ti
7%'.9 ,/y5.