HomeMy WebLinkAbout2004-06-16 St Paul Regional Water Services RPZ Test Report Jun 24 04 08: 44a p. 3
REDUCED PRESSURE BACKFLOW DOUBLE ENTER TEST REPORT AND
TESTABLE
SAINT PAUL REGIONAL WATER SERVICES
j ContacctPerson/Teele�.�
ServiceAddreName Vs 51 4 S-F- City:06/4 `L==- State: Zip:
Serve what system: -U
device toca5on: -
Serial Number.
Ar : Numt r M ke: t I. tib Model: ?.S ‘Size: �
Yipetx
P �-
Air Gap Inst:lfstion Date
Yiros .11 Date: — i .c. L./
Test Date: /f
R��uild D8:?:
Check V3tve#1
Check Vatic:=2 Differential Pressure Relief Valve
Anneala pressure.
RepectPressure s Opened a=="-L .osid reduced P
?Pressure �,,, Did not open
Leaned Cleaned
Ccaned Reptaceo
—' Reptac�-a
Rr}piar�ed
—R
Disc
Disc Dizc.Uocer
Spring pest.LowerSpine
? Guide Gude a
Spring
Pin Zebxun• Pin ReinerDiaphragm.Li
e
Hirrje Pin Lower
$cal _ — Uyr_ }ing
SnotcPin
�� piepnagm Uapnragm,&mil
t
S
- Di21:0120m ��_ Other.dcscncc — Lower
- Other'describe Other.
Y1 O 14e- Seat:
Lower
---
Upper
Spacer.Lower
Other.describe
L1 __I Sign;ane date Tag .- !p /ra d T
�./ �Q��r 02teTteC: �--
correct. 'd-"` °�
The above is certified Signed -� 7 E C�rtintion Nur,;b _
Tested by(Pert Name) _ .
> li
0.�.i CA' V lG_ • License Number •� -
11 PS
CcCcmPanY wane: �t:.-�t�._X - 1�` _ 3 ,� J
r ny Telephone Nurniaer Lc, wi �mhpr Of pev�tes F� r w '
M sections of this report must be completed. S 30
Regional Water Services First S 30
Return to: Saint Pau! Reg Devices 2 21
B 4th St E Ste 400 71 nem ~Pr c i'
gid 8409L-884- jS9
jjapoW d04 :L0 *0 LI unf