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HomeMy WebLinkAbout2018-08-16 Interstate Testing Cross Connection Control Device Performance Test Reports Aug.20.2018 10:52 AM Interstate Testing 7637555365 #0250 P 9/18 • Cross Connection Control Device Performance Test interstate Testing 2140 141st Ave.NW. Andover Mn.85304 Phone(783)7444149 OWNER INFORMATION_ Z ,lama -, •S�t Address � i_ Seto Ap Case (Noes Contact Person Tebptiane Harrow 1 vs", rot-Wi,S ' on. (6 C I ) F - Name ^ 8#et Addfees ,,y-w-ell C, h.,Cr City Fwd. c7� S�- S9- c ox A...._e 1t t( Laceiiin F4h` _1, _ k"�G w, I/)1.1-e L 5 ii-< w onaNcVair \ A4odd SON dumber w, j/:,� V17 '? cX — 3e�-7.P9� , E9ms 3 q Assembly Te ei$P 17 RP Detector ❑DC 0 CTC Detector 0 PV ilSNE ..iiiaii.'.':::. :� IN r771:-4 . 77171 ,9 ey: „ 3 '/ PSID Static I P310 Static ( PSID •Did not open dL BAAL Ivey ❑Oiaead kis 0 Gaavd tlgM Opened et PSID Static PSID Static PSID / ECTOR BYPASS ASS&V BRIDAL TEST ~' ��7n'�1 _,.p�d�,i RP80:I tight _PBR vNm tight CI LoWvid LJ D+d noI open PSIe7 Static P810 Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed Sight . Closed Opened at PS1D StaticP510 Static M PS1D PRESSURE VAGUUM ,ii +. , .., RE V • t h PENAL TEST .AltIMM valla iAlroisvto PS1D C���aatight :Opened at PSID Co❑�sy�ed SplitQDid�aotapen od Steak MD Statin P810 • COMMEMTB I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCT T EO BY ME PERSONALLY. Teeter Nome(print) r }n✓ PI y//st Regiatrallan Rio. o b�3? Time of Day TesterSirinetore PtIOneHO. (7E3) 7444149 Data 9I4 / Aug.20.2018 10:52 AM Interstate Tenting 7637555365 #0250 P 10/18 Cross Connection Control Device Performance Test interstate Testing 2140 141st Ave. NW. Andover Mn. 66304 . Phone(763)7444149 OWNER INF V! ....� „_ �.),`'" TrAi)-_,.,,,„ e 11p Coos I mss Contact PesZon teaseoi s Mambos SCA.. • I hs u6 *';. Zp Cot9e Comb A. ' -r. -ei" i7` 5 ] k _ v ,t 1 L�4 N ?' 11,'Ai t g.N 11'1 g 1 N 4,-€.,,r, y - Writ Number w JU ,-., 5 �7S yI-- F 3 -z__- Size Il „ ' Asserntahi Typo 0 R' .0 R•Detecitor 0 DC 0 DC Detettor 0 MIMS :.,. .. 4bria- '`>! PSID Static P51D Static o PSID A MAL T ti3 ❑Meed WA Cl Closed Wit Opened at I PS1D Static MD 3ta!tc PSID DETECTOR BYPASS ASSEMBLY IN AL TEST sr U 59M Geed tight RP mild J ILI.. ptit PSID 0 Looked °Leaked D bid not•. . Static PSID Static PS1D D87!CtOR BYPASS ASSEMBLY FINAL TEST ❑Closed fight D Closed tight Opened atf PSID Static PSID Static PSID '' VACUUM BAKER INITIAL • PsiT": . •4 VACUUM FINAL TEST Air initstsybal !;4.:.•• Y114,003 int Opened at PSID li Closed dont •Opened et PSID �ht U bid not open •Limited Static PSID Static PSID COMMENTS c 4-°-,, )-- -JY6-- . 4 a____ C:4-_-) I HERESY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY[SAE PERSONALLY. Tester Nano(prat) D O A el ! ' + 1 /lei Registration No.0 65.3-13 3Filme of Day — Tester Signature C 5�+-+-` f- Phone No.7!o 3 Date S)//Sp//. Aug.20.2018 10:59 AM Interstate Testing 7637555365 #0250 P 13/. Cross Connection Control Device Performance Test Interstate Testing 2140 14`9ist Ave. BIW. Andover Mn. 85304 Phone (763)7444148 OWNER INFOikTrOK . . . NOW / —"'�."Soroot Weis ie Act` �19r N"'y1v 4 t` ` State Zip Code Owners Contact P' on Tetophut a Kir T1 �r S ° .,I ( roil } 77 c5'cl F9r" @TY F 'Pl N r DA h'i :y1 XLLI/ - gst Addres Z.0%,,-(ti., code county/ 3 c 7 � S Pi:: S 7- "1c cityq Zip its(t)sertiZ A_-4e doh t c _ Lamson ,. L..,....../z4- j.r , tem "usModel Sting Number (A } 0 r.1 Q0., , 7 'S }4. 306‹ 9 ) Assembly Type n RP Dotoctcr Q DC 0 DC Detach 0 PVBJSVIB r.i w .ss�:.4....,. .i�I relief ti Q......�� ti '�!!' ..' Opened n4 P51D 0 Leaked /' • 88 :• L i❑l Did rtat open Static SA © PSID Static c PSI VaALyr ❑Cfoeed got a Closed tight Opened al PSID Static PSID Stn13c PSID DrECTOR BYPASS ASSEMBLY INITIAL TENT . ��, RPP realef vain u Looked 0 Leaked ❑Did not Czwi: at PSIS Static PSID Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed tight 0 aosed tight Opened at PSID Static PSID Static PSID PL WS$URE VACUUM T1" i:: a. PRESSURE VACUUM BREAKER FINAL MST AirlilaLvAtet �Att latmlate j OPer►ed PS It) ��ht .Opened at PSID U C ►tt �7�+d reot open Leaked Static MO Static PSC . COMMENTS ------�""� ' ..6.Li,*-- CANI) '.34- 2%- C:7t7 I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY, T �'t tj1 Tester lvame(print) D<� n Y1 Registration No. Pi r 4 ‘,fi 3.,3Tirvse of Day Tester Signature ��, t _ 6( Phone No. (763) 7444149 Date S ,1 (,-1 'it Aug.20.2018 10:53 AM I n t e r a t a t e Tenting 7637555365 #0250 P 11/18 • Cross Connection Control Device Performance Test Interstate Testing 2140 141-st Ave. WV. Andover Mn. 55304 Phone (T63)144-6149 OWNER INFOR$O K I . Neer tierpv_41 Sbeat Address /e$Dy 1-.¢J.s 9 `�►�L�.s { Stain Zip Coda I O ore Contact Person Te ephone twunoer (�+cl ) MARY BNFI�►F33i@A1 j;-L-71.,,e_4/14,1'-f:5":‘,LA‘c-> -7 71 S F-s cl paglIty Name Street A4dreea Cale County o<J 4 4 I,).e j h *-.3 —Assembly . 1.0 L-f..).e7 /1-1«il. R :..-'. 1 r r '5 1L ja t-,, Nbnuiacbua . Mods -&fiig Number she ) /2 Asenth y Type D RP Detector 0 DC 0 DC Detector 0 PVBMViii TEST .�... � — RP Kf lrjti5t� a�1n�� ed at 3, _ -- 411457.441,P6.9 PStb D Leaked D Leaked Did trot open Static / tom` P810 Static PS1D C0Ctoarad*iv 0 Closed ttpht Opened al PSD Static P810 Static PS1D • . .. _ -- DETECTOR BYPASS ASSEMBLY 1NM1l5. g miiitivin D` o d tightC. tight OOpp ned at PSID D Leaked D Lealaed ❑Old not open Static PSID Static PS1D (DETECTOR OYPASS ASSEMBLY FINAL TEST D Closed to rt 0 Closed tight Opened at PS1D Static PSID Static PSID • • FINAL TEST PitE88�UR1°VACUUM • ( 4�' lNfYII►L . . PRESSURE VA • �.• . Air inlet vpP *A.:, r i.: 4perted at PSID 10 Closed tight •Opened at PSID �ht LUJ£)d scot open •mod Static PSID Static PSID —m. COMMENTS M 51.. ,,,..sil--- . -0- 2-- C3 1---0 I HEREBY CERTIFY THE TEST RESULT'; ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(print) D<• a1.,.‘ 1j f / tea- Registration No. 8 re{;v�3.1. Time of Gay Tester Signature (94,.•, Rhone No. (763) 7444149 Data S)//6))A Aug.20.2018 10:53 AM Interstate Testing 7637555365 #0250 P 12/18 Cross Connection Control Device.Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn. 66304 Phone C7631744-614 on= , ....i.... f.� c N,i'/� c N? P. � r ,•.. .. .... • . «` ... . :anion Telephone ( ) FAINUTY INFORMATION Stoat i ckess 2-7"--- 1114‘11,,,t4-6, vv.,2 ii LFTitAih-5 ' /3‹ 7c- -512-1-;1 Sr- A/ 4, Qq L fteieAssamay Locoman � / 44" LC,‘,1-.)e•- 15.--; T-e_t-- jL‹. ''-"1 tienideldeOre •L„ — Model Sada Number w, l l �.A 37 c X.Z-' _ 13 a 1 •42 S stye / A Assembiy clap Detector :;DC ri DC Dewar Q:PVBlsyy 101.1.177,_ . .',17177rr t-i.".;11101P -4- , , Static P81D Static d • not open PSID / •Leaked D •Leaked Did MAL VEST Closed AIN ❑Cbsed sant Opened at PSID Static ',MD D ' Illic _ to I,..:...-O ■ ••.1 . tight a.'. .. ask. PSID ■Leaked ■Leaked • Did not open Static PSID Static PSID DETECTOR BYPASS ASSEMBLY ANAL TEST 0 Closed tight 0 Closed tight Opened at PSID Staltic PSID Staff M .. at 'Pap Erased agla as open `1 Lliaaed Stade Pero Stade PS1D - - ..-- COMMENTS __............„....,„_________6-4 e vi ---/T e / °".. 2--• C-----(.737-1--.\ I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Note xt) V n---N pi r I``e-Z listralion, o. &5323 i31= Time eir Day Tesler SigtAobureC 2..------ pkwne No. (763) 7446149 oats 4/6/./ P