HomeMy WebLinkAbout2006-05-24 RPZ Test Report 06/02/2006 09:26 6512289201 ST PAUL PLUMBING PAGE 04
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: _ Contact Person/Tele
Address: /y7c15 blt 4 W City: at & /reiii,,zState: !L_Zip: 5. 08
Devide Location: _t)oq k,'4� yo„�^o� Serve what system: Sen rX s'4�-� _
Account Number: __�,,,, , Serial Number: /dV Y
Type: RP Z fr Make: h/,ik i/)j Model: 975x Size: I
-
Install Date __?i Air Gap Installation Date //ift-
Rebuild Date: ? Test Date: ✓�--? "- O
a
Annual .Check Valve #1 Check Valve#2 Differential Pressurc•Relief Valve
Report
Pressure b-5— Pressure 2-1;-/— Openedopt 3 •Gf psld reduced pressure.
Did nvt•open
Cleaned l( Cleaned Cleane41
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
S Diaphragm Diaphragm _ Diaphragm, Small
Other, describe Other. describe Lower
Upper
.
__ Seat:
Lower
__ . Upper
— _ — Spacer, Lower
--- Other, describe
i1 _ ____
and
C V ) Sign date Ta `-- ----
9 9
'..a
The above is certified correct. Signed ' DzteTested; c-ay_ O
Tested by(Print Name) _ /10 5_ _l . _ Certification Number 6a 6G6 T
Company Name 51-,Pa ti i /n'/vin bird
_ ��a f,,�
'License Number
Company Telephone Number—,bc=a D'9- 93-o 6
All sections of this report rnust be completed N1t r1ber of Devices. Fee Lea Device
Return to: Saint Paul Regional Water Services First $ 30
,8 e-th Si E Ste 400 Devices 2-21 $ 25
Saint Paul, MN 55101-1007 22 and over 5 15 /a .--/s—
Return
/5Return with tee payable to the Board of WatAr (•mm�,(co{,..,--