Loading...
HomeMy WebLinkAbout2017-08-16 Interstate Testing Cross Connection Control Device Performance Test Reports 2017.08.18 04:23 PM Interstate Testing 7637555365 PAGE. 12/ 20 Cross Connection Control Device Performance Test Interstate Tasting 214E 1410 Ave.Nit/. Andover Win.613304 Phone(T63)744.6148 OWNER INPORNATJoJ 274 l ,:t,tddress .. 444GP-i9, °a. PC-,'.1., Erato Ep Coda (Sangria Conga Peron Ysbpnone rammer Lplit * Irr,.t.g G (.foCf Y F —II - T .r•;•r oLrA'h ill o.-t ^ Street Address L.. t Gthoc isc- 27,... 7 - S41- sr n4, County o T. A—I /k,�h�t< cd9)1+wih /c-Gsi. L/hmL.a., 6-7'4ir` Manurar£iN W I Ir .-et 57 cx( Sorted Number WI Rk. 31 LI Aesetubly Type allP 0 RP Detector ❑DC 0 DC Detector 0 WOMB VIAL _ ed ❑LeafedE t ht e •C PSID 'j �� 0leaked y •Old not open 8fteda / PSID Stade '6°IC Palo 0Posed-Tight 4cioeed tIght SAC P810 sleep PSID Opened ed MD DVECTOR BYPASS A SESISLY tpuAAs_nta aeratiebithfs CtiotWised Leaked tight Q L O �at PSID Static P810 Static] PSID ""'1°otopen DETECTOR BYPASS ASSEMBLY FINAL TEST ❑MIME tight ❑Closed tblit Opened at PSID &We PSID Staao PSID PRESSURE.VACUUM sakeA 4 i IRMM.Wet Stem uti!vACut M e1M�1talt/VEAL MST NrinetviNe ;Ah BM viw _ el® h :Opened at paD �e°"tRarron®etapen PSID Start PSID COMMERTS 6-4' 14L— c-T' 4.,_ --4.___. - c le I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY, Teeter Name(print) o et ill I 1/-,t ti Registration No.A '-06{?›In,Time oPDay Teeter'Signature "l.-., Phone Na. (783) 7448148 Data ->/.14/.1� 2017 . 08. 18 04 : 23 PM Interstate Testing 7637555365 PAGE. 11/ 20 Cross Connection Control Device Performance Test interstate Testing 2140 141st Ave. NW. Andover Mn. 66304 Phone (763)7448149 OWNER INFORMATION Address ' . Ze;-CS h 7?ke I"i 5.PN, /-/'4) r I Cede Orates Coefact Para= T et '+ 4".�1e`1�'e 65 ( L)— / ) 77 < �P t" ' FAAI INFORMAT18 1"P__ _is•a P, ► ►�a,oru ` Street Mdesa A0 z,.,e. ,n . /. ' e Si. 4Jv i'...1=-41 acv ,..u= Size -y y.°' Arl s biy Type 0 RP Cl RP e 0 DC 0 DC Detector 0 PVB/SVE rrAL TEF 2 a Li Cdaed t1Ght RPa,vs -'>-s) MIDwaked Did reot open Static P8ID Static 4' —P810 C7C'lciwdignt 0 Closed taut Opened at MID Static P810 Static P810 %TEMPI!lMPAU ASSILAISLY INITIAL TEST . Paoticl tight 0&rMYOf YU CiliciiMitsed Leaked tight CI L.aireti D DW OP� noto PM Stift _ P810 Static PBID DE'eciOR BYPASS ASSISIMILY! I AL TE8"T Closed tlph! ®Closed light Opened at P81D Static P510 Matto PS10 n • 'VACUUM MfAKER MIA.T'.►. P.' a.Y: Re ACUU 'T ' FINAL 7,- 1athCa p....., i. i.' ;Waist-vat& O_penod at MID al Cto®ed tight :Opened at P810 O4d eat aper^ M Limited Stale �� PSID SIatia P8(0 COMME{i(TS I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS COLI E H1(ME PERSONALLY. Tester Name(print) d.)0►'t et i i L Registration No.0 6 C3-23 3 Film°of Day Teeter SIQnature t7 9cr+-+-1 fr —a Phone No.76 3 Date Pl�f "1 2017 . 08. 12 04 : 22 PM Interstate Testing 7637555365 PAGE. 9/ 2C Cross Connection Control Device Performance Test Interstate Testing 214014" 4 Ave. M. Andover Mn. 56304 Phone (783)744149 OWNER INFO' „.;,. 0 . . • .! . Streit Address a' :•.to ... ..a • :ra Contact Fergon r ane Nurrmer FACILITY INFORMATION LA-,,,i,t ' N Oa h e 6� l � ��� — 8treet Addroaa OtY � ZIo Code County 0%. t�rT-i -Qi Vt. L.,...- 4 L A.^ i /'E i fl.e..c.. "•°^`. !Amu/0c ~ es 1 Modal Serial Numbor Sty It AsearulgyiNirpe P_) ❑AP Detector 0 DC ❑ DC Detector ❑ PVB/SV® tight lCloeed tight 'r oat st IYQ �j Q PSID 0 Leakod� 0 Leaked FiID d not open In ' PSID Static (1 p- PSID taMAL MST ❑Closed Vol ❑Closed tight Opened et PSID Static PSID Sia is PSID OVECTOR BYPASS ASSEMBLY INITIAL TESL . ...wet. fiP relief valve oLeaked 0 P31b Leaked ❑ t7id swt Dees State PSID static PSID O ThcTor BYPASS A$S MOLY P9MAL MST 0 Closed tight 0 Closed AIM Opened et PSID Static PSID Static PSID PIBMISURE VACULMI-MitifLANER immix. T13T ' PkiSSURE VACUllAKBR FINAL TEST • E1tr Dielyaty9 ell.'.. i..11' LAh'ktiat vstte C)penesd et PSID I Closed tight •Opened at PSID �ht CEJ OW wet open r Leaked Static PSID &sac P810 COMMaers -.,_ L ' tO--- I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. ' Tam Name(print) 0<'in p-,. .A1 1J 1 ,e e- Registration nio. ?? S 3.,)1. T1r e of Day Tester Signature, /�/ G Phone No. (783) 7444149 Date 1 L// 2 2017 . 08 . 18 04 : 21 PM Interstate Testing 7637555365 PAGE. 8/ 20 Cross Connection Control Device Performance Test Interstate Testing 2140 141a Ave_ MAL Andover Mn. 853O4 Phone (783)7444149 OWNER INFORMATIQr4 • • / c. F 1 $triDot Ad�►flr te5 y '.e_1-a .I pi, g�'�`k''k 1 c I Stall Zip Code Ore( ►tap Nelson Telephone Bdtlrr r •F -r . INFORMATION! ww (��:!' 'p ? f ° • Street •.*.$ae rr Y a.. Yip Coo. county 0< 4k k9--/ h 3 L,-9e7 /hi.caIN R4.0 ,,•.-- 1 rriJG4" " /..., Manufacturer . 1 Model ' Serial fiber LIJOrthc i ' '.2 < Y4-- _ , Size / /'- Asa C 0 RP Detector 0 DC 0 DC Detector 0 P1lB Ira. ,:r-- 1i f.oared t0aeired tightQRe COW VONCI y� 0 Leaked r nOt open 8taPSID CI tic C! P810 Static ► U_ 6 PS)D OWL TEST D Closed Gehl 0 Closed tight Opened at PSID Static PSID Static PSID 811, ECTOR BYPASS AMIABLY INITmALTEE1 0 Leaked CtOtieQ a Maori�I_ateicsd� � PSID Aid not opet, Static P610 Static PSI0 DETECTOR BYPASS ASSEMBLY PINAL MST 0 Closed tight Cc PSID I Closed ttuht P31D Opened at PSID PRESSURE 4ADUUNiabikicitt firms. ' CI' : . AcuUM . . . R FINAL rut AinIst !alio ti, .�. r 1, ;ttiliaktvge2 P510 Vont Opened at P8)0 o�ad t}g htLIOft Static P$tD Static PSID I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDLJCTW BY ME PERSONALLY. Teeter Name(pant) Dell,sN, i 1r E-ed" ROgtetratlon Na. 8F-Q 4-3.5.3 nine of Day l T..:•terSignature 2 - Phone No. (763) 744-6146 Data ,a1/1 ` 2017 . 08 . 12 04 : 24 PM Interstate Testing 7637555365 PAGE. 13/ 20 Cross Connection Control Device Performance Test Interstate Tasting 2140141st Ave. NW. Andover Mn. EE304 Phone(763) 744-8148 . OWNet.AR k ORMATi . • StrButA4irese A 4. 6" C. whil c U: ca•arson Yawre pl�oe hjirrt r --- a .. A/ d . = ( 6 P ,r- i r 4. -, i-tv,--k Adareee Pacitki Name,, I .1 n l il ) Sweet5 c1' - 'T Zip ede Gad* °lett k .P11.4 k gr it A7 s �- e.di 54 Asagis044- e ‘2 -1-1 tiered Mertes: � ,• Z� i1'7C ,74C- KI--- . 3°02'7 ,F5/<7 _____w_,$IA I1 Af} 6 P T 4 "- n RP Detector in DC 0 DC Detector 0 pjS IrIAL TEST RP velYe 6421 itt--te gelred tight Opened d PSID 0 Leaked 0 Welted �, ❑Did riot open Static 7 ' PS10 static 1 pSID Co°teea•Upt1t ®Chess tlgM Opened at PSID Stet c P81D Stat c PSID VECTOR BYPASS ASSEMBLY IN17iAL UST RP.-Met valet ❑dosed tight Cbeod tighat PSID Ci Leaked ©Le ked Did not open State PEND Stave P31D DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed ttpht O Closed tight Opened at P81D Static PSID Static - PS1D resume a VACUUM eitiamtit ilia AL TEST PRESSURE VACUUM d AEh FINAL TEST fQper PSID C tight :Opened et PSID Reck �osat9t� ti®ht Q idi not open to 14eaked Veda MD • Static PSID , CAMMENd rs • 3 , ± . JP . 1' 2-- .i-.' ---____ I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDI_ Q BINE PERSONALLY. Teeter Name(print) i a 0'1 J Jt 6 4-e- Registration No.c7 6C3-13 /4 Tinto of Day Teeter Signature (1,21-h.-h. r` --ePhone No.7(0 3 Date _ i 2017 . 08 . 18 04 : 22 PM Interstate Testing 7637555365 PAGE. 10/ 20 Cross Connection Control Device Performance Test interstate Testing 2140 141St Ave_ NW. Andover Mn. 88304 Phone(763)744-8149 OWNER aNFORMAT OJ µante st>�t Amies .Z._je t A_5 1.--:, ,,,-i.5 4_, 7481:kii.4e_ a is Zip Coda ftr5 Contact Pwson Te4opiladex Number 41e hi ( ) FACILITY I4F0RNAItION F ei Gam1 N7-7 City ""\Zip County SQL vf- C -aeeorwa Loo A � � . 1 .Qer UC.-CrG - ILL/ 1-a"- /C '.471- Nmn I'll c-'(,,-- manufacturer Number Ste i Aseonth1y Type C1 RP 0 RP Detector 0 DC 0 DC Detector 0 PVBISVB iPo TES —�— 614Z tilr--;081. Fjed tart _1° "' a f ®L elc®d PSID i O UId not open Static PS10 Static_.. —_. 1 PSID Esc J °Cooed tab4t O Closed tight Opened at PSID Static P511D Static PSID DETECTOR BYPA33 ASSIEliteLY 9NmAL TEM' RP reBotviltve ❑leaked ❑Leaht Ccireed ked C ed at PSID eaked Q Old not open Static PSID Static PSID DEnEcroR svpAse ABSk`LA2 Y F'tC9C.L TEST ❑Closed tight 0 Closed tight Opened et PSID fttic • P31D Static PSID PRE88Ue1E VAct}l)M ROMAKILIR INITIAL T 5T ' P T: :URE VA UN BREAKER Ft •. 6iLL1It tifi `L ,.5 ;Atr In1 Reck YarrlQnt . PSID :Ope tM nod a4 PSIDLOd eo ■Us ked Static P31D _ Static PSID COMMENTS .� , 6. °( vi * .,..-Ab • --4- .2,-- (4) -___. • I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. To's*ane(Prune) D,,h ,i fl/),// el` Registration No.O dG.�.4,;13 Time or Day Teeter Signature Q..."--+r -E. __ Phone No. (763) 7444144 Date P/I.zi? 7