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HomeMy WebLinkAbout2018-05-30 ASSE SRVB Reports - Pedi Chairs ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State MN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: Location of A4sembly and Equipment or System Application: In wall access behind Pedi chair 14-1 COO Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (lc) Leaking ( ) Initial Test Opened at 1, p h psid Pressure Drop AcroAs Closed Tight ( x} Check Valve#1 1 7 psid Describe parts and repairs when needed Leaking ( ) Closed Leaking { ) Tight Opened at psid ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone #: 952-212-0826 Pass x License#: PMO66299 Certification# BFO66299 Fail Signature �� IT"""`` Date: S`3C --/g Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City oak Park Heights State ZIN Zip Code 55052 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: On-2 3 Location of Assembly and Equipment or System Application: In wall access behind Pedi chair 1Iv + Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure; 582SI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at r• `I psid Pressure Drop Across Closed Tight ( x Check Valve #1 I• psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PM066299 Certification # BF066299 Fail Signature /li^,, e a Date: S 30-M Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State i ZN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: 0/06, Location of Assembly and Equipment or System Application: In wall access behind Pedi chair f LCad Test Equipment: Manufacturer: watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PS1 Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (x) Leaking ( ) Initial Test r at Opened p ,`1 psid Pressure Drop Across Closed Tight (x) Check Valve#1 psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester(print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License#: PM066299 Certification# BF066299 Fail Signature J �� c --;'z;.`_ Date: S`3° /8 Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State MN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: V/90g Location of Assembly and Equipment or System Application: In wall access behind Pedi chair f� t Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at It b psid Pressure DropAcro Closed Tight (x)Check Valve#1 1 psid Describe parts and repairs when needed Leaking ( ) Closed Ti Leaking ( ) ht Opened at psid g ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PM0662 Certification# BF066299 Fail tcreork Signature Date: 5 -3d-1 b Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State cv Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: O/ y Location of Assembly and Equipment or System Application: In wall access behind Pedi chair qt 3 (. c ll Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at /( 7 psid Pressure Drop Acro Closed Tight ( x) Check Valve#1 /� ? psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester(print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone #: 952-212-0826 Pass x License #: PM066299 Certification # BF066299 Fail -11,74;Signature �`-' Date: ,T-,50--/g Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights Slate M Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: 01q01 Location of Assembly and Equipment or System Application: In wall access behind Pedi chair 3 H°-t- Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PS I Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at p 1, 5 psid Pressure Drop Across Closed Tight (X) Check Valve #1 psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone #: 952-212-0826 Pass x License #: PMO!62x99, ertificati>.#BFF066299 Fail .?7 ,7"Lta-rtirrivdt. Signature Date: S^3 0-j Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard#1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State MNn Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: Q Kid, Loc tion of Assembly and Equipment or System Application: In wall access behind Pedi chair loll, Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking { ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at / �f psid Pressure Drop Across Closed Tight (x) Check Valve#1 2.t ( psid Describe parts and repairs when needed Leaking ( ) Closed Leaking ( ) Tight Opened at psid ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PM066299 Certification# BF066299 Fail Signature Date: 5 - 30-%g Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State MN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: ©M>/ Lo.cation of Assembly and Equipment or System Application: In wall access behind Pedi chair /4f Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (X) Leaking ( ) Initial Test Opened at p A3- psid Pressure Drop Across Closed Tight ( x) Check Valve#1 /, 2 psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve #1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone #: 952-212-0826 Pass x License #: PM066299 Certification #. BF066299 Fail Signature Date: �� g Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State , Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: O/8 J/ Location of Assembly and Equipment or System Application: In wall access behind Pedi chair W $ Ct, 1 Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 :30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (x) Leaking ( ) Initial Test Opened at 7sid Pressure DropAcross p Gs Closed Tight ( x)Check Valve#1 /, / psid Describe parts and repairs when needed Leaking ( ) Closed Leaking ( ) Tight Opened at psid ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PM066299 Certification # BF066299 Fail Signature Date: Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Haig-hi-5 State MN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: 0 1C1/ L cation oAssembly and Equipment or System Application: In wall access behind Pedi chair Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 :30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (x) Leaking ( ) Initial Test Opened at / psid Pressure DropAcross Closed Tight ( x) Check Valve#1 h b psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PM066299_ Certification # BF066299 Fail Signature Date: S Comments or Recommendations (continue to other side,if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard#1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th St N City Oak Park Heights State iiN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: D/ 5Ng Location of Assembly and Equipment or System Application: In wall access behind Pedi chair T- b co (d Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight Leaking Initial Test g ) ( ) Opened at 1, psid Pressure Drop Across Closed Tight (4 Check Valve#1 7,-7/ psid Describe parts and repairs when needed Leaking ( ) Opened at psid Closed Tight ( ) Leaking ( ) Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester (print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone#: 952-212-0826 Pass x License #: PMO 66299 Certification # BF066299 Fail Signature / Date: ;O-1 iS Comments or Recommendations (continue to other side, if needed): ASSE International Spill Resistant Vacuum Breaker (SRVB) ASSE Standard #1056 Field Test Report Owner of Property Shangri La Nails Address 14725 60th st N City Oak Park Heights State MN Zip Code 55082 Occupant of Property (if different from owner) Occupant Address City State Zip Code Manufacturer of Assembly: Watts Model #: 289 Size of Assembly: 1/2 Serial #: Location of Assembly and Equipment or System Application: In wall access behind Pedi chair Test Equipment: Manufacturer: Watts Model #: TK-9A Serial #: 408226 Calibration Date: 3-15-18 Date test was performed: 5-30-18 Time test was performed: 2 : 30 Static Line Pressure: 58PSI Air Inlet Valve Check Valve Shut Off#2 Leaking ( ) Failed to Open Closed Tight (x) Leaking ( ) Initial Test Opened at b psid Pressure Drop Acro Closed Tight ( Check Valve#1 1i psid Describe parts and repairs when needed Leaking ( p psid Closed Tight ( ) Leaking ( ) Oened at Final Test Pressure Drop Across Closed Tight ( ) Check Valve#1 psid Certified Tester(print) Nate Blaylock Assembly Final Test Address 5400 Nathan Lane N Performance City Plymouth State MN Zip 55442 Phone #: 952-212-0826 Pass x License #: PM066299 Certification # BF066299 Fail evriLna Signature Date: /K Comments or Recommendations (continue to other side, if needed):