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HomeMy WebLinkAbout2017-04-06 Mid-City Mechanical Annual RPZ Test Report - Watts 71136 04/13/2017 08:28 7637868640 MID CITY MECHANICAL PAGE 03/03 ANNUAL TEST REPORT REDUCED PRESSURE ZONE BACKFLOW PREVENTERS DOUBLE CHECK VALVE ASSEMBLIES MANUFACTURER td-5 MODEL 001 p12 Q T SIZE / '' SERIAL# 71136 NAME OF FACILITY VetLvpt z,,,e_ T",+-4.,.t O;( Store. 744 COUNTY ADDRESS (STREET, CITY, ZIP) 5 60o Area,/ 4✓ n!; Ockt P..,-!c I-t _% ki-S/ LOCATION OF DEVICE IN BUILDING go w&r 1�Ve- SERVICES WHAT SYSTEM Niaxi,., 1;,,R, f ilk} p. ter ttr •)-r�9.�.t..,‘ ,5 O e... CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT346PSI TEST CLOSED TIGHT (}c ) CLOSED TIGHT (X) REDUCED PRESSURE 7.G DID NOT OPEN ( ) DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC. ASSEMBLY ( ) DISC HOLDER ( ) DISC HOLDER ( ) 0-RINGS ( ) STEM ( ) STEM ( ) STEM ( ) RETAINER ( ) RETAINER ( ) SPRING ( ) 0-RINGS ( ) 0-RINGS ( ) DIAPHRAGM ( ) SEAT ( ) SEAT ( ) SEAT ( ) SPRING ( ) SPRING ( ) SPACER ( ) GUIDE ( ) GUIDE ( ) OTHER--- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER— ( ) OTHER-- ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: No I"eta.i r 5 rept.)lee-c3 FINAL CLOSED TIGHT (,X) CLOSED TIGHT (x) OPENED AT 3;0 PSI TEST REDUCED PRESSURE INITIAL TEST BY 1--'"r"`4 ga.ut�‘e DATE 4 -ó /? SIGNATURES/3 REPAIRED BY /V//t- DATE '------ SIGNATURE "------- FINAL TEST BY: MID-CITY MECHANICAL DATE V-6 - /7 SIGNATURE ,i,e,..E0 9103 DAVENPORT ST. N.E. BLAINE,MN 55449 (763) 786-8617 PHONE CERT. NO. 2IO 8''2. Id (763) 786-8640 FAX