HomeMy WebLinkAbout2017-02-08 Roto Rooter RPZ Test Report 12 10:34:45 a.m. 02-17-2017 1/1
ROTO O ROOTER PLUMBING SERVICES CO.
BACKFLOW PREVENTION (RPZ) TEST REPOR T
14530 27th Avenue N.
Plymouth, MN 55447
- /+,,, ?! L@ _
763-559-3522 .
Customer _.9tin4 Ls--,?),0Ls--,?),0Cevais Device Location J L@,,.
_Site Address cQ'6 ...520414-_6e }}(?Wit) System Isolated -ps
-City/State 24 -Q AM/ 33—(302,2 Install Date 2/.S (Jce#
Contact Person _3( Overhaul Date .�' , d
Phone Number &S i—g 9 9' (3 a Test Date .0, O' /7
Type of;Assembly: RPZX DCVO - -
Make C(.A/kfb4s Model / ?O LI aSize 34/'34/'y'
7.sX� Serial Number ?S.-7
New Replacement, if applicable:
Make • Model Serial Number Size
CHECK VALVE#1 RELIEF VALVE CHECK VALVE#2 CHECK VALVE#2
r,, BACK PRESSURE CONFIRMATION
11 Leaked Opened at: I u(' psi D Leaked ❑ Leaked
34
Closed tight ❑ IA Closed tight 4 Closed tight
Dltfererli--I pressure'--- — Did not open " Differential pressure-----DifferentiaFpressure- ---- --•
(Pg
—• psi - — —_ �-- psi �2 ? . psi
❑ Cleaned only ❑ Cleaned only ❑ Cleaned only
Replaced. Replaced: Replaced:
❑ Rubber kit ❑ Rubber kit 0 Rubber kit
❑ CV assembly ❑ RV assembly ❑ CV assembly ,
or disc or disc or disc
❑ 0-rings ❑ 0-rings ❑ 0-rings•
❑ Seat ❑ Seat ❑ Seat
❑ Spring ❑ Spring ❑ Spring
❑ Stem/Guide ❑ Diaphragm(s) - ❑ Stem/Guide
D.Other,specify: ❑ Other,specify.' ❑ Other,specify.
❑ Other, specify: ❑ Other,specify: ❑ Other, specify:
Final test after repairs: Opened at: Final test: Final test:
psi psi psi psi
Comments.
I hereby certify that this date is accurate and reflects the proper operation and maintenance of the assembly.
J
Tester's Name: �1frti G� ��ffell License#-Certification# Bra3927d
Tester's; ;ignaluru Date Dot/ �� /7 A_ •
1.6actoi Ph17f111.^-f r1--•.,n 1 .,1,..-..,.... '1RCsr.Gld