HomeMy WebLinkAbout2019-09-27 Interstate Testing RPZ Test Report Sep.30.2019 11:32 AM Interstate Testing 7637555365 #3590 P 2/ 2
Interstate Testing, LLC
P.O. Box 55
Anoka, MN 55303
REGULATED BACKFLOW ASSEMBLY (RBAJ APPLICATION FORM/TEST REPORT
COMPLETE JOBADDRESS(INCLUDE Apt/Unit 0) NAME OF BUILDING.OWNER/OCCUPANT,CONTACT NAME AND PHONE NUMBER
5990 Nova Scotia Ave, N. Bremer Bank (Oak Park Heights) KeHlly ec(sel (651)312-3215
Oak Park Heiglits, MN 55082 Kelly LlecKsel ....
APPLICANT COMPANY NAME CONTRACTOR LICENSE it CONTACT NAME AND PHONE NUMBER
Interstate Testing, LLC PC751575 0 Q n.r MileJ (763)744-6149
ADDRESS CITY STATE ZIP EMAIL
P.O. Box 55 Anoka MN 55303 interstatetestinqAcomcast.net
TESTER NAME TESTER CERTWICATION# PHONE
Donn Miller B=065323 (763)744-6149
TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL# TEST EQUIPMENT SERIAL# TESTING EQUIPMENT CALIBRATION DATE
Midwest Instruments 845-5 05090906 01-16-18
F`,.'71, ,I, 40.:4;j5-;:,,,,, .'1::!':•D.:!i't9..4.',C('?.'7
r.7.040#4:105IAii 6 FEE'Ii4 FORIVATI OK(0 kit one .:.'''..',.,.,.:,,,..,g.A.-•'..;5• ','.:.,-;441::.::,',','i..,1:.
Install Relocate Remove Replace and SNO of Replaced Device _Rebuild X Test
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Type(check one): . ..... Reduce Pressure Principal Of Prsure Principal Fire Protection, Reduced Pressure Detector Fire Protection
Double Check Valve Double Check Detector Fire Protection _Pressure Vacuum Breaker..._Spill Resistant Pressure Vacuum Breaker
Manufacturer:VVOttS Model# 009M2 Serial 1 AQ0110 Sizeinches)
system serviced I rri q a tio n Location in bidg Risor room gear# Room tt RiSOr
P•-gY 11t:OV.'.4A41121:1003H.'\..E;I:041t., .''!,A(0,"elAiftgisft' 7,40.0 6#,O.,i,4,. ..:i, tr, iti_i,iit.:;, !*, E:4.:i,i.b.,,4-,•,,,,,,1*t. .51)2. ...-,;:.:,.:„.:',.'' --;:: •:
04#44441,..:,#`.,iiifiiitiifi,po.:fi*fot,*tto4c*it4;.000,4ie:oyokooKkvo::**to'o*ixlg:tvq,f4T.Aov)-oA,ir,,,.R.;:?;.i:':;:w: : ::
Pressure Differe,ritial
Check Valve#2 Shutoff Valve#2 Check Valve#1
Relief Vail/e
initial Cloed Tight X Yes No Closed light .Yes_No Closed Tight .X.,..Yes—No
Test Opened at 2,2 psid
Pressure Drop Across Check Valve#1,9.2 psid
Final Closed Tight _Yes No Closed Tight Yes No Closed Tight —Yes—11/410
Test
IYOpened at psid
. Pressure Drop Across Check Valve#1, psid
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„, . ... . .
Check Valve#1 Check Valve 42 Shutoff Valve#2
Initial Test closed Tight Yes No psid Closed Tight Yes No osid Closed Tight Yes _No
Final Test Closed Tight Yes No psid Closed Tight Yes No psid Closed Tight Yes No
14;;; :•::::".,: Fir' S4illi*444e*ii440j0,(/.6):ti 1Ts*k$k4;r7i,‘'(/44iifii.41:6ki(skiii40ii***!# :, :?2qr.;*i:.ti;,,I:
Air Inlet Valve
initial Test Failed to Open _Yes No Closed Tight Yes CheckNoValve
_ 1 Shutoff P2
Closed Tigtrt Yes No
Opened at. psi d Pressure Drop Across Check Valve#1___psid . _
Closed"Reit Yes No
al Test opened at psid PressureClosed Yes Drop Across Check Valve#3. _psi d Tight — No
.. .
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I Describe parts and repairs when needed: I
EC RTIFICAnom I hereby certify the'foregoing information wmride.dbymtw . . rect and that the test device Is functioning in compliance with
State of Minnesota Plumbing Code,Chapter 4714. P)/111
___
TESTER'S SIGNATURE TEST DATE09-27-19