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HomeMy WebLinkAbout2019-01-10 Norblom Plumbing Backflow Preventers Test Reports Jan. '4. 2019 3:59PM No. 0740 P. 1 NORBLO 1465 Selby Avenue St.!num G ' _- uE( cc (MN 55104 5 Office:(612)827-4033 BACKFLOW PREVENTER TEST REPORT Fax:(651)340-8631 Job Address: bOv5— K 0c`Sk inkttbl> 1Mn�15—oga- BackflowAssimbly Information System Served: MAN ttla Manufacturer: 4147.4 Model#: cf75- L X Size of Assembly: s Serial#: (Dc1(0•6 \ Location of Assembly: ripck 4bek,- . Test date: t—h)`ly Reduced Pressure Backflow Preventer(RP)-TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight: Closed Tight: Closed Tight:_Yes _No Initial Test _Yes _No Yes No Pressure Drop Across Opened at_ psid Check Valve#1. psid Describe parts& repairs needed Closed Tight: Closed Tight: Closed Tight: Yes _No Opened at`3.° psid Final Test _'es _No es _No Pressure Drop Across Check Valve#1 $, osid Double Check Backflow Prevention Assembly.(DC)-TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 • Closed Tight:_Yes _No Closed Tight: Yes _No Closed Tight: Yes _No Initial Test psid _ psid Describe parts& repairs needed Closed Tight: Yes _No Closed Tight:_Yes _No Closed Tight:_Yes _No Final Test psid_ psid Pressure Vacuum Breaker(PVB)or Spill Resistant Vacuum Breaker(SRVB)-TEST RESULTS Air Inlet Valve Check Valve Shutoff Valve#2 Failed to oper _Yes No Closed Tight: Yes _No Closed Tight:_Yes No Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts& repairs needed Closed Tight: Yes _No Closed Tight:_Yes _No Final Test Opened at psid Pressure Drop Across "" Check Valve#1 psid Tester name:--�� Tester signature: State of Minnesota Certificate Number: q(A3QQF Date: I"(0-(9 SM41 t4.40.140k otis-�r�s O IJ clev,srl �S�wt-air Jan. 14. 2019 4:01 PM No, 0740 P. 2 NORBLOM 1465 Selby Avenue St. Paul, MN 55104 • LUM G KiAc, 7� Office: (612)827-4033 Fax: (651)340-8631 BACKFLOW PREVENTER TEST REPORT ( ) Job Address: o��i O'( Cc�.es�•4rz_, 0...,c.&A-K c 'Q Backflow Assembly Information System Served: _i-01X34, ,3 Manufacturer:altt(i i Model#: 17611,, Size of Assembly: I Serial#: g91,54o4 0 Location of Assembly: Gaic S�ck e--- Test date: I"t0' Reduced Pressure Backflow Preventer (RP)-TEST RESULTS Check Valve#2 j Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight: Closed Tight: Closed Tight:_Yes No Initial Test Yes _No _Yes _No Pressure Drop Across Opened at psid Check Valve#1. psid { Describe parts& repairs needed Closed Tight: Closed Tight: Closed Tight: Yes ,No Opened at 1 .1 psid Final Test }OYes _No Ales _No Pressure Drop A ross Check Valve#1 ,g psid Double Check Backflow Prevention Assembly (DC)-TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve #2 Closed Tight: _Yes No Closed Tight: _Yes _No Closed Tight: _Yes _No Initial Test psid psid_„ Describe parts& repairs needed Closed Tight: Yes No Closed Tight: __Yes _Nc Closed Tight: _Yes _No Final Test psid psid j Pressure Vacuum Breaker(PVB)or Spill Resistant Vacuum Breaker (SRVB)-TEST RESULTS Air inlet Valve Check Valve Shutoff Valve#2 Failed to open: _Yes _No Closed Tight:_Yes No Closed Tight: _Yes ,No Initial Test Pressure Drop Across Opened at psid Check valve#1 psid Describe parts& repairs needed Closed Tight: Yes _No ' Closed Tight: iYes _No Final Test Opened at psid Pressure Drop Across Check Valve#1 psid Tester name:.- • 6 t.�;.. Tester signature: ��0, �� State of Minnesota Certificate Number: X26 IS 6v Date: A-tn-11