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HomeMy WebLinkAbout2018-08-16 Cross Connection Control Device Performance Test Reports - Interstate Testing Aug 20.2018 10:55 AM Interstate Testing 7637555365 #0250 F 15/_0 Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave.NW. Andover Mn.39304 Phone(763)744-6149 OWNER iNsTKat rtdetta 4,,,_.,,,,. Seek Address . „Air , . ' .-e . :,.CoAo ... .:..,Boated Peramr 's+uPhone•umber 7:1'.."1-11.74-!'t ( 6C/)) 7 Z IJentt¢ BseeC Mertes td Zip Gaol, county Seim Nu �� = mNar j L,k)11 ,, c X't.— l G�`'7v ,) S' 2.411ssatt4 Type ZAP—,El 0 St 9 OC Detettor 0 name INITIAL TEST ar4Isor_�.. BP.TII&4Lva , caked13 L.* Letfked ht ]]�� Er rid �' a PSID Static g PSID Stark O t P810 Q AIIOLIQBT Clawed iota 0 Cines tion Opened al PSID Static MD Static PSID DETECTOR BRASS ASSEMBLY INITIAL TEST ..���,�,n�a,+,rn` sawn Old> {J(dosed linat MO0 Leaked 0 Leaked art open Static PSID Steric P81D DETECTOR BYPA85 ASSEMBLY FINAL TEST CI pissed Hotta 0Maed tion Opened at PS1D Static P510 Static PS1D PAMsSURC VACUUM BREAKER INniAL TEST PRESSURE VACuTUM BREAKER FINAL TEST EiLltdebsttet Alt inlet valve PSID M :Opened at PSID dozedaght=even �ed Static PSID Static PSID COMMENTS I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name(print) l wr 0,> +-1 it lj f i-e.. Registration No.06C3a3 4 FTIrc,ta or Day Tesler skeletons e(2c'— . /"t-c-e.� Phone No.7Cv 3 Date 9/K../AP 7914(6/V, Aug.20.2015 10:55 AM Interstate Testing 7637555355 #0250 P 15/18 Cross Connection Control Device Performance Test fti interstate Testing 2140 141st Ave. NW. Andover Mn. 515304 Phone (763)744-6149 OWNER INFORMA1, Owtw kerne Stoat Mt!teea A ' sd e c ze 5 A '•• ., •Coco dwresr`a Contact Menson Toloprwrw kurnbw P.. t 0 •• T 4 �;. 1".t/,„ { 6 c /) _CA ►-r4� •_R X50/"- • ••• 1•••, Name Street Address o ° wle / : h , .../ . 0 A..)vL.- .. " w • M1 I. CtUffty 0A LofrI.l ile1A Niatxri401uplr ,. 7r. 4. 'umber i) 1_/4 J n,i j_=2 S 4_,, w 1 ? v 8 Sks 3 , T E+itt•- D ..... R� for D DC 0 DC petector 0 PV1318V8 C r... t. (C Red t Opened liP5etietat ve �' PSID 0 Leaked S : - 0 Lease ❑Did not open SLatFc PSID Static O PS10 FINAL'i EST CHCosed Vaal O Oozed tight Opened at PMD Static PSID Stdsfc PSID DETECTOR BYPASS ASSEMBLY INITFAL TEST ItPyt: O Closed tight gajtioVSed tightat PSID plinked CI Leaked Did not open Static P81D StBA$c Psio DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed tight 0 Posed tight Opened at PSID Statin PSD Static PSID PRS VACUUM RAMER itaTtAL TEST PRESSURE VACUUM BREAKER FINAL.TEST Ekidetilltd1 �r.�«. iAk. Y Votrtd nno0 stet PSID ti Posed tight :Opened et PSID Cbsed tight LUJ Did Aot epen f Leaked 8t .MD Ste& P84D , COMMENTS k -t. 4 .,, L -3Y- 2___- a I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Name(print) D a h "Z m t 11-4 i. Registration No.a 6 C 3 A 3 3 rTiale of Day Tester Signaturet, /c^- - >�`� _____ Phone No.76,3 Date 8//k,Ji Aug.20.2018 10:55 AM Interstate Testing 7637555365 #0250 P 19/18 Z ' Cross Connection Control Device Performance Test 1 interstate Testing 2140 141st Ave. NW. Andover Mn. 55304 Phone (763)744-6149 O N & Strset Address ___k_s„, 'SnAILDe 6'1 ,ei rl '''-—i-A: .te _ 1 ../fid'm,l 'l''cAi ( bC 6" 7-) 'C c-2 c ') F .9'r,'FOIR3 l� 1U49 1A..: . , ..:..., t saeetAdd n A • rip Cute r CcWi ! A ).k iler . •a:. jat/t. 3 4 9 t if=4)4,1 5 A e./ 4- ^' /a.c.pa., _A z/i,ci,.... "IA le:A._ ,-,A �. SortS Muster � ) L/ --q • X5'7 ' ' e,�66C Mfr +_ 3 •' " A r_. -,.. T.'•' - D 0 DC ❑ DC D _ l,uST ., .. RP HAW valve c7..... .tot eli...! M at PSID . oLsa+xd S .e 0Leaked DOdnotopen Static PSID Static PSIS flilitAllEST ®Closed Vont 0 Closed tight Opened et PSID Static PSID Static PSID DrECTOR BYPASS ASEBi1LY INITIAL TEST • RP DAM vette Cksod t $TtOpe a at PSID 0 Leaked 0 Leaked ©DW eat open Static PSID Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 hosed tight 0 Closed tight monad at PSID Static PSID Static PRESSURE VACUUM BREAK INITIAL TEST . (P�yR�@.SSU`.RE VACUUM II EAKP{t F111A//L���TEST LQer� �sID IClosed tgM :Opened At PSID �tight PSID �Didsiot� Limited Static PSID • COMMENTS & + 0) ? C-27,j) S I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED DY ME PERSONALLY. Tester Name(print) D a ii n /'i / 1 J-.i. Registration No_04,C 3-23 g rTlroe of Day Teeter Signature /ern Phone No.7(o 3 Date ` 7q46./ V