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HomeMy WebLinkAbout2017-09-13 Backflow Preventer Testing Reports - Nasseff Mechanical Contractors i , .. 1 ... MECHANICAL .1, CONTRACTORST ) a ) -i 3 s�,rik Co; S ® AU L, MN 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name:lkick, Wc,-Ver �``}'"'e^+ Pew^-} Contact Person/Tele: 1 ^ F0 x 60- no - 07 Address: (o) 6 3 Su-in{- C ra►s Tom``, City:S).Cro%x Vu,)Ly State: 1V ) Zip: 5 5 og,2 Device Location: PRE- 0 der F,1-6r P-6,..+ Serve what system/n: ?r hen Account Number: Serial Number: 1i ` 0 Type: Maket4,10 Model: Size: /i 11 Install Date: Air Gap Installation Date: 140 a 0 4 O I Rebuild Date: Test Date: Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve 8 Report Pressure 2_ Pressure �r Opened at psid reduced pressure. a Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large I ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm, Small S ._Other,describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other,describe [®] Sign and date Tag The above is certified correct. Signed AG U 0ia.. DateTested q-3—/-7 Tested by(Print Name) xy LA,Aed Certification Number 13ro6ogc) 91 License Number PM061479 45Ser 76(73 , ASSEFF RECEVED MECHANICAL 0 I liv3 ..i., CONTRACTORS sr, L(-09X PAUL, �A City of Qak Park Heights ® PAU L, M N 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 0 ce - —AM r" REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name:Li 4,s Wojcs- TreljrnerA PL„+ Contact Person/Tele: .Pu-" FOX (a ]�� 7010 51 c Address: (. 1()3 Sc:tn+- ('ry 0 X T(2 I eseity: Si; C.) iX (Mei State: /'/I N Zip: .650 49 Device Location: B 1„,,j cf-r C Ile-m Serve what system: Account Number: Serial Number: c a 7 8 3 „ Type: Make: a P,�(/, Model: Size: OZ. Install Date: Air Gap nstallation Date: — ft -Py - Rebuild Date: Test Date: Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve .2 Report Pressure (p,Li Pressure dc, ((I, Opened at psid reduced pressure. Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large I ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm,Small S ❑ Other, describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other, describe [Z] Sign and date Tag The above is certified correct. Signed Rutra 5.4t, DateTested q'13-/7 Tested by(Print Name) ()ry L,,,re Certification Number e EO 6 0 9a License Number PM061479 UU 1)-3fG 7(,,03 t. ;. MECHANICAL .,„ CONTRACTORS 19, 11 35(,,nk ccz S1 sMN 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Fo Ia -7qo--5107 Service Name:U.10,,>feWu, Trwo-mteb+ 64.4/- Contact Person/Tele: DCC." X Address: C, 1(03 ,„,„-}. C ra,% T ‘$ %A City:s,_,„- Croq 14.,lic y State: AO Zip: 55 0 8c Device Location:Lowef Ltvcl, &A i:- ,.r;40/""15” Serve what system: B6Ae.r- Account Number: Serial Number: P 3141 �� Type: Make: nb �� Model: Size: 3�y Install Date: Air Gap Installation Date: y Dot 04 Oc Rebuild Date: Test Date: Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve 07, 4 Report Pressure 7,0 Pressure i-k Opened at psid reduced pressure. Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large I ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm,Small S ❑ Other, describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other, describe [®] Sign and date Tag The above is certified correct. Signed klazyo- j.,.At DateTested (-/3 -/ 7 Tested by(Print Name) cityry L-nz. Certification Number 2 F©6 oq Z License Number PM061479 5 SG 'F 02 7(0 d.3 ASSEFF is .. MECHANICAL .„ CONTRACTORS # t a ] i y 3 P50.,A Go�,F PAU 9 N 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name:Wci.s�'e-Wt s Tr-e. mer,4- PL.,i Pecs, R x !, 1'2- 790 - 510 7 Contact Person/Tele: Address: t,16 3 Sc:.;‘, CO%x mix,i City:Si. Croix Vi'Llk y State: /A N Zip: 5506, . Device Location: A 9A- MrOh Serve what system: 11.0 r"i &IFier Account Number: Serial Number: 'D 3'1 q$ Type: Make:C,nb ,,t® Model: Size: 3/4 • Install Date: Air Gap Installation Date: 4 O O 1Oe Rebuild Date: Test Date: Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve / el Report Pressure Pressure Opened at psid reduced pressure. Sig 0' A Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large I ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm, Small S ❑ Other,describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other, describe [®] Sign and date Tag The above is certified correct. Signed /` 31- DateTested 9— ! 3 Tested by(Print Name) ,^y L u..ne- Certification Number 3Fto6agzq License Number PM061479 ,1SSG' 1i .9 76 03 , A .h Ia111-I3 -.- MECHANICAL 4,., CONTRACTORS 5w, 1 cioa,x L3 M 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name:41/4)0,-.A1:-W°` rr }"ei`f PLA Contact Person/Tele:3 R'< 6/02-790 -51°7 Address: (0 163 Sc_ 1- Cro ix rrwi I City:Sfs CP,x Va.Iley State: m N Zip:37-00 g Z Device Location:t)V Serve what system: P l s i n fec tfi... Account Number: Serial Number: E.-47 596 Type: Make:C ! n 6ewtc Model: Size: /7z, Install Date: Air Gap tnstatlation Date: - Cl-- Of/V of Rebuild Date: Test Date: Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve ' g Report Pressure Pressure l cY Opened at psid reduced pressure. I i / /-fe l Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large 1 ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm, Small S ❑ Other,describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other,describe [®] Sign and date Tag The above is certified correct. Signed 1. DateTested q_ 13 (7 Tested by (Print Name) f' . , Certification Number lT } n,e gro_6oga9'9 License Number PM061479 i15.56:0 ,72 7 6 03 ASSEFF .. -.. MECHANICAL 4. ► a 114 .4, CONTRACTORS 5,,,,), Cc , ST. PAUL, MN 122 S.Wabasha St.Suite 101, St.Paul,MN 55107 Office 651-777-0001 Fax 651-602-9296 REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND TESTABLE DOUBLE CHECKS Service Name:ViG-S z, W0.7t` rre4-1-rn.'d PL,-,i- Contact Person/Tele:Dcc.n F (o [a' 7W /07 Address: (p 1 b 3 Sc._i^t Cry`" ' I City:$ -, Cro kr. V JLLy State:NI lV Zip: .5.5 0e L Device Location: R45/ 3sn1 N r Corncr Serve what systenx -7 Account Number: Serial Number: _ 0 00 1 Type: , ' Make: C i.\\jra uo Model: _. Size: Z Install Date: '' Air Gap Installation Bate: - 4{}a 0 q 0 7 Rebuild Date: Test Date: i- F Annual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve Report Pressure aPressure \0 Opened at psid reduced pressure. O Did not open❑ ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Replaced ❑ Replaced ❑ Replaced R ❑ Disc ❑ Disc ❑ Disc, Upper E ❑ Spring ❑ Spring ❑ Disc, Lower P ❑ Guide ❑ Guide ❑ Spring A ❑ Pin Retainer ❑ Pin Retainer ❑ Diaphragm, Large 1 ❑ Hinge Pin ❑ Hinge Pin ❑ Lower R ❑ Seat ❑ Seat ❑ Upper ❑ Diaphragm ❑ Diaphragm ❑ Diaphragm,Small S ❑ Other, describe ❑ Other, describe ❑ Lower ❑ Upper ❑ Seat: ❑ Lower ❑ Upper ❑ Spacer, Lower ❑ Other,describe [Z] Sign and date Tag The above is certified correct. Signed , ""l_ L. r� DateTested "l- 1 3 / 7 Tested by(Print Name) -,-ery Lr.e. Certification Number OF0 6 License Number PM061479 ��;2a(� /�ssz- 74903