HomeMy WebLinkAbout2017-08-16 Cross Connection Control Device Performance Test Reports - Interstate Testing 2017.08.18 04:21 PM Interstate Testing 7637555365 PAGE. 6/ 20
Cross Connection Control Device Performance Test
interstate Testing
2140 141st Ave.NW.
Andover Mn.88304
Phone(783)744-8149
f 5(010 i )(71Wc ) �6-.U�
OWNER NPORMATJOl�
Omar Marne Stet:Um/oat/
uy tot. Zip Gads Dtmeta aOrtind PUMA draPcm 7eaanac,
D'1-a AP ir. l''f6-,,.,-§ ( x.s i) 7 7 s ¶ ? 7
IPACILtryINFORmATiON [iU-tAr...--, ( • h4,,1-t. /
' 1VNte % street Addmec
0
UI/i 1_1( i ' .AtK,
Aawnbly
ElanUMttuker Mood k sertel Ticrnbr
LL) /fir,I 4 ? 7'V ?e,4- 1 f/f9/ 7.0 sr
8B7M 3 ty^ euadgg►N' ws EAt Ll RP gagar ❑g ❑ I)atags 17 FNH!
Trim_TEST
— MAW.lIO� t 0 Leaked / Opened et °7 Q P863
pStatiasked s)' Z= PS1D .i I C P81D ®old not open
17NALIEST
❑ClaedVat ❑Ciceedtight Opened at P81D
Static MID Static P810
DETECTOR BYPASS ASSEMBLY INn1AL TEST •
�����¢ RP ree+
®CIoeW hate Cbeod tientoponod et P81D
°Leaked ❑Leaked ®DId not open
Static P81D StatIc P810
DEfllIcTOR IMAM MB*MBLY INIAL TEST
❑ttooad tight ®C+aed tight Opened at P81D
Sonic P81D Static P81D
PURE VACUUM e18Mtf INITIAL Mit— PREest t 1 VACUUM BREAKER FINAL TEST
AR ktbtvowe ,Y a 'i Alt inlet calve s
Opened at P81D LJ L aed egM Opened at P81D
Old ad open Leaked CSbilic�ht PSID
Static PEND
COMMSNT8 • ,.
S4 t C .4,74 AL. ,,
i HEREBY CERTIFY THE TEST RESULTS FARE TRUE AND THE TEST WAS CONCOCTED BY ME PERSONALLY,
Tester Name(wiratj D 0:'t 6-1 /21i 4141,e a Registration No_0 6 C 3-23 K rTtrne of Day
Teeter Signature(9r'-w 141-e-et Phone No.74,3 Date 2
7 c Y t i./,
2017 . 08 . 18 04 : 21 PM Interstate Testing 7637555365 PAGE. 7/ 20
•
Cross Connection Control Device Performance Test
Interstate Testing
2140 141 t Ave. NW.
Andover Mn. 55304
Phone (763) 744-8149
OWNIM INR
7 r �' A\ ' -c ,ill V I�'' d ' e sttw4 Addroe,+
4 State Zip dodo (w mfo Contact Person t aiaptsane Manilla(
r
,••••, Name Sweet Address
cf
� � �r� 11� t � f � lip Code , . .
Azoomb‘ociaaA L ' /3d' ,4.4a �dc )16.1r 4ic, . 'i A
moat Model -Aeries k,erricer
size .3.... '.".':.►_... ;, : GRP DRP 8 . ,•.,;; .r 0 DC 0 OC Doctor 0 PVB/8V9
Ngnm.TEST
I e4 rl�F� i� 6eea tiQht BEsSBA lette �' PSID
D
tar ' �' 0 Leaked t a not open
Static _ P81D Static 4 I PSID
ARAL 104
OCtoeed 1Qht C1C4oeed tight Opened at Pato
Stark PS10 Static P3ID
•
DETECTOR BYPASS ASSEMBLY}NRAL TEST
_uG71ob tight C0ls&d tight
PSID
0 Leaked 0 Leaked 0eD denotopen
Static P810 Static P810
DETECTOR BYPASS ASSEMBLY ANAL TEST
0 Cued We 0 Closed tight Opened at PSID
Steno PS11) Static _ PS1D
PRS VACUUM eRfAaER**nu ' P R CUti itcr.AKeit ram TEST
i. ... , Alskielyatite
Qperted et ligni
F610 4 . . light :Opened at PSID
� ht
U old cwt open •Leaked Stade PSID
Stack P840
COM WIEN`rS
45k _ 2 ` C
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED QY ME PERSONALLY.
Taster Name(print) 00:10-it frtd)-e_fr. Registration No.O 6 c 3 a 3 8 .Time of Day
Tester 8iQnature (196.----i-• tl—tse-9 Phone No.76 3 Date ?/k3i/ 7
7 qY ;/ t