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HomeMy WebLinkAbout2016-09-29 Interstate Testing RPZ Test Report Sep. 30.2016 04:45 PM Interstate Testing 763 755 5365 PAGE. 2/ 2 1 Cross Connection Control Device Performance Test interstate Testing 2140 141st Ave. NW. Andover Mn.46304 Phone(766)744-6148 i OWNER INFO 6ATION _ . . , v+e+ti Nemo Ak6 k_Lq._1/42LiLl' litkg) �Ryyes�fall' C41 � <.r Ar f e r 'Munson TMoL -Nu er — • • F,,•"1-- i T'.'..,l'T__.'.�,., , Psolea►rents ttllbatAdd►eea 0 p12),474.en 4-A- Apq,1% K.-- c'it 7 43 kr'U 1 4:C. o% I- t A /C) .1, <. Zip Cods "'� j _atitledi 4 e IP' /1111 , C• rc..1644.1 a i*- Rop a ,tiot friii ."--77-------1. _ Ark Model tt Number 5- 0 6t". P1 cr0 0 <7 4tre l ' Amenably Type '•el DRP Detector ❑ DC ❑ DC Detector ❑ PVRIIVE _ TIAL MIT light fiP milers i q no ,. 81iMb ad `? , PSID I PBID Otd nat open CI ed ht ©aimed tight Opened at P810 Static P810 State PSID OSTECTOR BYPASS AMIIIMMILY INITIAL TEST � BE teeef valva CJ Clamed tightCboeed lightOpened at PSII) ❑Leaked ❑Leaked ©Dld not open Stella POD Static PSID DETECTOR SWAG ASSIEKSLY FINAL TEST O Closed tight 00oaod tight Opened at PSID Static PSID Static PSID P SSUR!VACUUM I Tn :1, PRESSURE VACUUM BREAKER IFI Alr nlet valva ►1 ,.. , , lAnJJatyatMa ;� ed P81D tr Closed light •Opened at P810 �I�ht a Oidsotopen a lodged Seib PSE) Stele PSID • . COMME . M I HEREBY CERTIFY THE TEST RESULTS ARE TRUE NO THE TEST WAS CQNDUCI D BY ME PERSONALLY. Tosser Name(print) Registration No. Titue of Day Teeter SlQnoture Phone No. Date Sep. 30.2016 04 :44 PM Interstate Testing 763 755 5365 PAGE. 1/ 2 Interstate Testing 2140 141 Ave NW Andover MN 66304 Phone Number (763) 744-6149 Fax Number(763) 755-5365 Email: Jnizerstatsteetinata comcast.net FAX TRANSMITTAL. FORM To: ( cls 4. 4 k t i k From: Donn Miller Date: 9 -9--/6 Fax: 6.5/ 5'3 os--75z Number of Pages: 1 Message: P2 *-s r---eoy//- "e" Fes` ,5 444.64 4'ty If you should receive this fax In error, please notify Interstate Testing at (783) 744-6149 This fax Is Intended to be viewed only by the person or people listed on this fax.