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HomeMy WebLinkAbout2017-08-16 Cross Connection Control Device Performance Test Reports - Interstate Testing 2017.08.18 04:24 PM Interstate Testing 7637555365 PAGE. 14/ 20 .0. w• Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave.NW. Ando%rar Mn.B81O4 Phone(78S)7444149 OWNER IFORMAT2y ' ?1 . ov�mrrem,b; i sneetMame 'mt. 5.,Coda Dwnore Congeal Person p age r FA r 9i$ORMATiON >f (_r�" -A / � is 4 S G f' 7 8 S P 9 Kane l Santa Maass /9 o J' LiedI L_7A .'l ' .,t• Cw, City zap h// 141,41-c , �,4 , cd1 2ri�5 A./4-t, --ooh ,3e//W.,. k- -. .194 u..isf l4 �4 9", *S- X(-- I 419664,C- Ste 3/9" Aaectoddy p• - D RP ter 0 DC 0 DC Detector 0 PVIBJ . VITAL T L TEST fJg ,y �t6esd tlptd tlgh6 el �' d PSID O lertosd °Larked old not open Stats 2^ PSID Stoac PSID macaw ❑Cloeedlpt* UUSW ltgM Opened al PSID Stack P81D 8tetic PSID DETECTOR BYPASS PASSABLY INITIAL TEST I EIP roIof NIvp lJ Cbsed AptClosed tlodOpe��ed at PSID °leaked D Leaked O DId not open Stade PSID Stoat PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed tight 0 Closed light Opened at PSID State PSID Stolle PSID PRililURE VACUUM BREAKER INITIAL Ttirt PRtsSURE VACUUM BREAPER FINAL T1lS yTy�p Ri at McM •Ope at Pslo UOlo.edlffiht Dtaantopen tanked Static P81D Slaec PS1D COMMENTS ll c-`kx r. 44- Z. cr I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY, Teeter Name(pc t) t,_lieI;1 o'1 /11 i 11.e h Regletra ion No.06C3a 3 R�Tlrae of Day Tester SWnebtre C 2'- f�-e Phone No.7(o 5 Data��'�/,(//7 -7/1`,.( /(/', 2017 . 08 . 18 04 : 24 PM Interstate Testing 7637555365 PAGE. 15/ 20 r • Cross Connection Control Device Performance Test ! Interstate Testing 2140 141st Ave. NW. Andover Mn. 611SO4 Phone (763)7446149 OWNER INFOR3.�IKTe . owner t3 m. soeeet Atkkeee tg, �,6 Peci114is �+ 2 0 C Owners Coact Parson telopkonie Number F wtx c 1 11—, Ad'rte+.57 � d)lei t 6C17) 7'7 -c" ;) '� /Mme \ '-'7 .ft.4'1 S�ry� WIW °'Sitii 1,1 ^ 4i . 1co ./1.1,Lcth p., , k ,,t„, CH:0 Zip Code dainty 1 e * ; � ' l - CrgAA.,; k sizo 3 '' y Type RF'Detector © DC O IDG DO(*CtOr 0 PVB/8VB Irma.TEST Static v Pd RP rollers 4/, PD � 2:17Xlitot open PSID Static (5t PSID IRNA:IIEST QCtoeed VII ❑C10100 tight opened al PStD Stella P81D P810 DETECTOR MYPAU ASSEMBLY INITIAI.TEST Iliei Ara IIIM C°g d RP retighte4 vakrs PSID 0Lashed Ca Looked ars.notopen Static PEW StattC PSID DETECTOR BYPASS ASSEMBLY FINAL TEST o Closed tight 0 posed tight Opened at PSID Static P810 Static PS ID PieltSI JRf VACUUM SRBAK1 R Mk 1AL'Tts7 OrtEaluntivActiteai mutes(FINAL T'P.$'f thkidatigi Pl.'.s.'.-. 4' t.' i� k3L@� Oaenod at Y8ID 1 dosed tight 'Opened et MOLJ powd light �t Did not open Leaked 86e fic P810 Mete PBID COMMENT ,c< , y-- .c.21I.,--Li ,2— a-, I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS COND(JGTD BY ME PERSONALLY. Tester Name(print) D d%t PI /21 , i i-e_in Registration No.v 6 c3.23 'g *-11n;e of Day Tester Signature C2c�'- "1-e- `-' , Phone No.7423 Date 2/i/c/0 74/'q (;/q 2017 . 08. 18 04 : 25 PM Interstate Testing 7637555365 PAGE. 16/ 20 Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn. 88304 'Phone v1444148 OINE. @!?�iF .�'. Stnet Addlroee g_r____i ithilte coda • ,es •A. teat' ' amu°? E emer AMM LpL l4:51 mortal ,� -, c � i c d LA.). ;' 6 ' Cl DC ❑ DC Detector 0 PVW8V� .� . �+ LtUilfb--0 nRPDe or I1 71AL TEST p y^� `spy 0twened Leaked 0%7 C1 Leaked , t, Did not open StaticPS1D Static a `f— pan El VA Wein 'at MIDCtt�oeea�aagt 17s1D Static P810 Static DETECTOR BYPASS ASSEMBLY INITIAL TEST ftEnfithebot light C7 Cloesdl da nopeneed P81D Q Leaked ©Looked ® open Static P810 Static P810 D TE Toll BYPASS ASSEMBLY FINAL TEST ClosedPSiD 0 closed tight 0 tight Opened og Static P810 Static PS1D • .17'. . .. v «-t u1M 71 <., . • . PRESSURE VACUUM l .ems Tr4T iNr inlet Vika) Openedkat P810 �M •Opel ed at P510 U G701sa tight O Did slot open► Looked 8taila POlO Static PS1D • COMMENTS I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDU E PERSONALLY. Tooter Nome(print) 7)a r pi 1 1 be,- Registration No.0 6 x 3 3 3 Nitre of Day Taster Signature (2,-w"1"k• _ -"- Phone No.7(m$ Date 1' ii / / 7 7gq %, g5