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HomeMy WebLinkAbout2018-08-16 Cross Connection Control Device Performance Test Reports - Interstate Testing Aug.20.2018 10:50 AM Interstate Testing 7637555365 1:0250 P 5/ ' Cross Connection Control Device Performance Test Interstate Testing 2140 1418t Ave.NW. Andover Mn.56304 Phone(763)7444149 OWNER iAltkEOLL___ {aye lT SPINA A61:16666 a . r ' • f�I° 1 l' ' Cade Ow orb Contact Person Teleptane N a-F V { 3 Ls V 5.,_1.. (�4 d) 7 ? 4: ; c'i ; rqft pp 0 { ,{L`-i6treetAd<LBas ,� p- ) j .t-t, 1/ 'Iel(ih5 `_ ✓vI J, !, tek,)1 /q, (9 / P i N'e L9 A t < ()01 91 anoetnNy Loonitool 1 4- R./ / ,- 0(, 1-t . ii'1.6z h P :tom Num m.Flsra . /J . ,sp,mTl P RP 1►p0«'e4n 0 r4 0 c Cy s' 0 PV5MVS INRIAL TEST � 7 41R4111. sa— aPorry��em 3, PSID e Leaked ❑D4 dot nope+, Static R•(~ PSID Static 'c P610 • {RIMEvolt volt ❑Closed tight Opened at PSID Static PSID Static PSID DlfTECTOR BYPASS ASSEMBLY INITIAL TEST .�,m RP vdhre UAri1-1hthatight gel!,lien -pponod PSID ❑Leaked in Leaked ❑Dtd rot open Static PSID Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Cloned dgM ❑Closed tight Opened at PSID Static PSID Static PSID PRESSURE VACUUM BREAKER INn1AL TEST PRESSURE VACUUM BREAKER FINAL TEST 1..:,. 1 . wAk Mrls4 vahe U�s�aned.a PSID ■C7oaid,tight •Opersedat PSID Cbasdbght C71 d t open A tseeYod Static P51D Static PSID COMMENTS � Skrr, 4- c...i /` •H. 7 C oK' I HEREBY CERTIFY THE TEST RESULTS� , ARE TRUE AND THE TEST WAS CONDUCTED BYJIE PERSONALLY. �' Tester Name(print) D .,.Z /r 4 1`'e.,- Registration No.V 6 413-23 'i rnrae of Day�! Tester Signature C 2r,.."-s. /--� Phone No.76 3 Date`'lhik? '74' (G/y, Aug.20.2018 10:50 AM Interstate Testing 7537555355 #0250 P 5/10 Cross Connection Control Device Performance Test Interstate Testing 2140141st Ave. NW. Andover Mn. 66304 Phone(763)7448148 53c-10 0 i lc-(U_,,Com. rk.tx. , CASIELIA r mortes �' f d '1 S t Mitass _ - Z / -tp Code Ott Ccniact Pis Tal,Wtone Faun ia. 4�a�41t 4 Pt Ae 1.°14 2 t "hs Y . to ` Gimet Mamba g• r; ) e..".� CIC, kale p 1a,• - , L.; : ...ccs • d01 Z q 1 .e c ,, ' - ftasernigy t 1 L. 7 /rti 5-x'1 1 'tn 1 ,1 West Imi.o0er est a L . 1 I _ ? 7 i X 4-- [ S U - 1 :: r.: ..rm n ix, ❑ ,ti. ':;i..:Ariz ❑ 1" .r.ti Leakedal' " 111111PHIP ' II 0 t ked II Did not open Static1"- PSID Static /2 et - PSID 6161A'IEST 0 used tight Opened at PSID Qaa�sd aght Static PEND P510 DETECTOR BYPASS ASIEMBLY INITIAL TESTP v eirs light Ck t Opeied at PSID o Leaked 0 LeOkfld 0 Old not open Static_ MID Static PSID DETECTOR BYPASS ASSEMBLY Ri4AL TEST 0 tight Closed tight Opened at PSID a cooed Stade PS10 Static Ps10 • • . , VACUUM BREAKER NODAL PRESSURE VACUUM •• . •• FINAL TEST MAIMLYNYti !!1. r.. t•.t.: iAi Inlet..h. ErVatv4 Opened at n PSID I tighttightne Opened at PSID ❑per 0 Did net opeLooked PSID Static P810 _ COMMENTS -ck.-A '/ a)Y 2 0� I HERESY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS COt{T1;�q BY ME PERSONALLY. Teotor Name(print) 7)a ►'T 1ai I !J.A. Registration Na 06C3-13 8 r-nr e of Day /n Phone No. Date 1 4 Tauter Signature ��o�+-L `�-� 7 74/'16/ 91 Aag.20.2018 10:51 AM Interstate Testing 7637555365 #0250 P 7/18 • Cross Connection Control Device Performance Test interstate Testing 2140 141st Ave. NW. Andover Mn. 55304 Phone(763) 7444149 SERI - � 5C10 )ICY�,I,.cJ. P)CLL ___4j2.S.11.4._ z_il r" )1 b' 11')-e' i Contact Pawn Nurrikila .- d+ .4 ' . : • , • ( (; ; ;) ¶". ': j 7 ;, n3i Aothaia P t- 11 ! _ 45 C% a i- A ,9 %k a 1....;�. at, Z3o ..... .*.!i: Amainibiy t.ornto•+ )_ L CtAAR`f -� _.. , iened at ' ` '' ,c ,� 3 1 7 PSID IS1 )d 8y r.Looked Did not open Static StPS1D Static PS10 0NAL tight O Closed O Untied tzgnt Opened at PSID ed 1l Static P81D Sia c P$1D DETECTOR BYPASS ASSEMBLY INITIAL TEST 1 RP ret*f valve fm$:;1 -sed tight 0 Closed tightppenea ut PS10 ©Leaked 0 Leaked ❑ not pen Static P81D Static P810 DETECTOR BYPASS ASSEMBLY FINAL TEST Closed tight C7 posed tight Opened at P810 Stsqk PS10 Static PSID • . .••• VACUUM BREAKER INITIAL TEST $ PRESSURE V B. i - •.:TTi7• ' TEST istidittyvat tve Air virEve ' ��PSID li Posed tight Opened PS10 heod_dpot open ■UAW ' static PSID Statla PSID parr .wu+� r COMMENTS A.-., -c-IV\ l' - __ (2)- 1 HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(print) a:'N .1 PI 1 1)- -a Roglsltation No.C7(o f3-1 3 3 rTtrtr of Day Tester S1an:ture C1 �-,---et Phan No.7 Date �/ I L'I