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Home My WebLink About2019 Interstate Testing RBA Reports Aug.25.2019 01:21 PM Interstate Testing 7637555365 #3296 P 18/19 Interstate Testing, LLC P.O. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT COMPLETE JOB ADDRESS(INCLUDE Apt/Unit 4 NAME OF BUILDING,O OCCUPANT,CONTACT NAME AND PHONE NM UBER 13575 58th St. N. Presbyterian Homes (Boutwell Landing) Dean Evenson (612)503-7498 Oak Park Hejcgjis. MN 559e ,q�an venso i APPUCANT COMPANY NAME CONTRACTOR LICENSE 13 CONTACT NAME AND PHONE NUMBER Interstate Testing, LLC PC751575 Donr Miller (753)744-6149 ADDRESS 1 CITY STATE ZIP EMAIL P.O. Box 55 Anoka ,MN 55303 interstatetesting a( comcast,net TESTER NAME TESTER CERTIFICATION# PHONE Donn Miller B=065323 (763)744-6149 TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL rt TEST EQUIPMENT SERIAL# TESTING EQUIPMENT CALIBRATION DATE Midwest Instruments 845-5 05090906 01-16-18 .i_i �y. -• n � Inn J i is �?�' `f t a'^ `.I%: i t.. \� ., �. : i:" 'YPE. FWbRKAND`F,EE. NFORMATlt��nt',(t +ieck;;dne) ,l• ti't,.,`.,, ^�. lu�: 4 Sha•_ yL •:!Jn �.i. � �Install Relocate _Remove Replace and SN#of Replaced Device _Rebuild X Test 4*??! IL^.N.D TAI F .,ORM ;Yk {�, ; �,. r� t y_ Type(deck one): X Reduce Pressure Principal or Pressure Principal Fire Protection Reduced Pressure Detector Fire Protection Double Check Valve Double Check Detector Fire Protection _Pressure Vacuum Breaker Spill Resistant Pressure Vacuum Breaker Mnnurfacturer:Wilkins Model# 975XL Serial 30278966 stze;3/4" Cinches) System Serviced Location in bide Fountain Room, under stairs Fly tt Room tS Fountain s f �j + sea►{ : '' Fad (COMP{ 'A! ►'JJ; AS5EMe`>> 7• -L• ." W ¢ r �^w 1•..•�'Mr S>' 1 al.� $)1 �t • - Y.. � {a �,.'? w • F :?� Reducee Pte ui ;P d1 or to uced r # ure:DeteCtgrFi� ,P cit , o• Check Valve Erg Shutoff Valve 42 Check Valve 41 Pressure Differential Relief Valve Initial dosed Tight X Yes e1.tVa Closed Tight X Yes No Closed Tight Yes.r No TestPressure Drop Across Check Valve 419.8 psid Opened at 3. psid Final Closed Tight ,r.Yes_NO dosed Tight —Yes __„No Closed Tight —Yes—No Opened at psid Test Pressure Drop Across Check Valve 41, psld Cetk tak sit t ick0.ei th'Fir _ rpfeOlon r.rci�. Check Valve tt1 Check Valve#2 Shutoff Valve A2 Initial Test Closed light Yes No psld Closed Tight Yes _.._.No p,id Closed Tight Yes No IT 1 Fine est Closed Tight Yes _No Oslo Closed Tight Yes No psid I Closed Tight Yes No . '•r_ _ ,�`�I uJ a valcullurn Bt4a lie .>rPvV j+or spur mane Val o m R akev(5 lVl TEST RES{l4 , ' s r ,... :i r. Air Inlet Valve Check Valve Shutoff 42 Failed to Open ,.._._Yes_No Closed Tight Yes No Initial Test — —^ Closed Tight 'Yes No Opened at__„„psid._ps,d Pressure Drop Across Check Valve 41 psld Closed Tight _Yes _No Final Test Opened at psld Pressure Drop Across Check Valve#1 r- psid dosed Tight Yes— No Describe parts and repairs when needed: CERTIFICATION: I hereby certify the foregoing information provided by me to be rect and that the teste de ce is functioning in compliance with State of Minnesota Plumbing Code,Chapter 4714. TESTER'S SIGNATURE TEST DATE; Q8-23-1 Q Aug.25.2019 01:22 PM Interstate Testing 7637555365 #3296 P 19/19 Interstate Testing, LLC P0. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT COMPLETE LOB ADDRESS(INCLUDE Apt/Unit#) NAME OF BUILDING+OWNeIVOCCUPANT,CONTACT NAME AND PHONE NUMBER 13575 58th St. N. Presbyterian Homes (Boutwell Landing) Dean Evenson (612)503-7498 Oak Park hipight5. paN 55082 Dean Evensori....„. .._.......... APPLICANT COMPANY NAME CONTRACTOR LICENSE 0 CONTACT NAME AND PHONE NUMBER Interstate Testing, LLC PC751575 DQnr Miller (763)744-6149 ADDRESS CITY STATE ZIP EMAIL P.O. Box 55 Anoka MN 55303 interstatetestinqa,comcast.net TESTER NAME TESTER CERTIFICATION tt PHONE Donn MIIIer B.=065323 (763)744-6149 TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL It TEST EQUIPMENT SERIAL t! TESTING EQUIPMENT CALIBRATION DATE Midwest Instruments 845-5 _05090906 01-16-18 x x +i Y>PL0,0 WORK AN 1F~EE*F001'411'6 ,Ch is Rite .• h _install__Relocate Remove —Replace and SNIT of Replaced DeviceRebuild X Test r. �, Ee ' x- AtKFL !l►sAS_e,MPLR:a ET AIL INFOR 1ATIO +" •i r ;',i t + r�� , gay- Woe(check one): . ,,,,Reduce Pressure Principal or Pressure Principal Fire Protection Reduced Pressure Detector Fire Protection ._ Double Check Valve Double Check Detector Fire Protection —Pressure Vacuum Breaker_..,,Spilt Resistant Pressure Vacuum Breaker Manufacturer:Wilkins Model a 975XL Serial it 3027832 Size-3/4`° (inches) System Servked Trash Chute Rinse tocation in bide Lower Laundry Room Floor Si Room# Laundry ti • „,,;�..t,•r:�r R,.,.�Td',u0c��r�0�+`•�!ar�( , ��•:; �rEte. dL'iu:;.c+� i:�, A�tWcGfEAw' � 04 :E5�FyS�REk FiPfecttlt ) YET SUU�LT}�C' Check Valve 02 Shutoff Vehre$t2 Check Valve 01 Pressure Differentialr Relief Valve initial Closed Tight X Yes _No Closed Tight ZL..Ye: No Closed Tight ,2c6...Yes No TestOpened at 32 psid Pressure Drop Across Check Valve 01 1 0.0 psid Final dosed Tight a Yes_No Closed Tight Yes No Closed Tight _Yes__No Opened at psid Test Pressure Drop Across Check Valve 41 psid :�' ' ' `s ,`', , �.t out�it�'C.bM i Vati1 o�F. oubl'eCbeck.Oet cttNr 'Protet U n DCl-T T Jt SULT %y °. ': t'fi Check Valve 41 Check Valve U2 Shutoff Valve#2 9nitlal Test Closed Tight r Yes No psid Closed light Yes No _ psid Closed Tight _Yes No Final Test Closed Tight Yes No psid I Closed Tight Yes No psid Closed Tight Yes No `(PVH)or$p It;,Res1* as Vacur+ *04kOtr SI,VB)-` Si Air inlet Valve Check Valve Shutoff tt2 Initial Test Failed to Open _Yes____No Closed Tight w__Yes ,__No Tight __.. Closed Yes No Opened at psid Pressure Drop Across Check Valve t11 psid Classed TiOt _Yes _No Final Test Opened at psid Pressure Drop Across Check Valve#1 psid Tight __,_Yes Na IDescribe parts and repairs when needed: CERTiFtCAT1oN: I hereby certify the foregoing information provided by me to t and that the testa ce Is functioning in compliance with State of Minnesota Plumbing Code,Chapter 4734, TESTER'S SIGNATURE, r ,�„�� -_.,_•,,, ,.�,�, ., �_„�—T1ESTDAT1E:� Aug.25.2019 01:19 PM Interstate Testing 7637555365 43296 P 17/19 Interstate Testing, LLC PD. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA] APPLICATION FORM/TEST REPORT r COMPLETE JOB ADDRESS(INCLUDE Apt/Unit tt) NAME OF BUItDINO,OWNER/OCCUPANT,CONTACT NAME AND Pf-WIE NUMBER 13575 58th St. N. Presbyterian Homes (Boutwell Landing) Dean Evenson 612)503-7498 O P r H h M v APPLICANT COMPANY NAME CONTRACTOR LICENSE b CONTACT NAME AND PHONE NUMBER Interstate Testing, LLC PC751575 pony Millet' (763)744-6149 ADDRESS CITY STATE ZIP EMAIL P.O. Box 55 Anoka MN 55303 interstatetestinq(c�comcast,net TESTER NAME TESTER CERTIFICATION# PHONE Donn Miller B7065323 (763)744-6149 TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL# TEST EQUIPMENT SERIAL# TESTING EQUIPMENT CALIBRATION DATE Midwest Instruments 845-5 05090906 _ 01-16-18 y,yr• .,�� ,� �;. t ^Y.^ v,J,rYe„ 00:4 . �,• '0:-...-0,A4,:,.-.4,,,;.-...,,,,,..:;-,,, GVH+'• �••�^�p:��r^ { n Y Y wily•.";ri•;s� t yi .., , „ •.r;� •• ;.;;• ^t f� •r�,• �,.r:/',gv.hi:'i• •'T -��C i"t•` Ri J" � t0i040A V C *;.'4" `` 5'00...;,.iy�, t .i r 5 !; 'kr; •• , • iivt' r,/.::F'•1VL�•t••_7�,n r�iC-c ,,•,�.,.•.,r..�Y'y F, •\,+hL w;.R1,' . 1� a � ., .., a.Cj'k`.h3'�h' ..:t yz.Y�,r,, t y .., jt_y . •.ri Install Relocate. Remove • ••face and SN#•f Re•aced Devi . Rebuild X Test ♦.. .hr};+,,�, tZ > ✓.+ Sr:•z1.,at•{, . � 1 6 K (y��/� } ,t�77yry��..�bwl ��y,`^�, 5: r',j�:.l•.�.t;i'�°r"^.C'.:r "ai.::,."t";,I•' ',',,,,. r;j�..(:..t,i.o Type(check one): .,,,Reduce Pressure Principal or Pressure Principal fire Protection Reduced Pressure Detector Fire Protection ,Double Check Vahre Double Check Detector Fire Protection ,.-,_Pressure Vacuum Breaker_Spill Resistant Pressure Vacuum Breaker Manufacturer:WiIkitlS Model# 975XL serial tr 3Q65453 size; 1-1/2°` (inches) System Staked L� p f♦ {fR {� Location InbldgLower �Boiler �Room pFloor# Room* I. ^P...i ia,wrf fg:14##la"Tr RESU,TS:;�P�;� T*� t/�ti MPL "f .,!.r 'A$S 8L i °l^ a.'WT1O�R BELOW .\ t ..k a yam, r �y,� �j y�,�, 4 p ,, rem y��. y�• . Y J r..e:'5_^y�',a (.' R�edt! ` eesure.P 1ntdp 1. .f iW''''�id'PresMli-'-' `9*� �i.. ' e;cdon RPC.--ESRRESVLTS�'. r. ,�`'"'„�' ..,77 Cluck Valve isl ShVaAre IYl Check Valve#1 Pressure Differential Relief Valve , lnitiet. Close Tight Yes _No Closed Tigt►utofft ,Y,Yes_,,,No Closed Tight X....Yes,,,,,,r No Test Pressure Drop Across Check Valve#1.10.5 psid Opened at 3.8 psid Final Closed Tight ,.,.,,Yes_No dosed Tight Yes Na Closed Tight —Yes—No Opened at psid Teat Pressure Drop Across Check Valve i!} psid P .\r n.. r\ lr: r: '»•' :r.Y\'. .'A�:"+;^" r.:^7'> 'T'. :Xr^ .. .. ° .v ... .ten•, F,., rrc r.'; �.:\°h��t• ,V q ^. ,,; p... t ^ ra,n�'�G t ^in,�:'.t�•'!'•. r • ..,4,12'Q)1,-,;;0,;.:, .,,,tJ,�C).r^ht¢Yh'��.`,4'�. F•`:�`-�"P': ..,. , !N�!T`P"'7„ !.�r71+'...��r!�`^,V��F.,�,C�R,^+4..F{�t•217..�Ff��l ��F+"�Cs1�, r��!,sV4,,;+.ef4.Y b,ti r•'n h, "``. Check Valve#1 Check Valve 42 Shutoff Valve 112 Initial Test I Closed Tight Yes No psid Closed Tight Yes ....No psid Closed Tight _Yes _No Final Test dosed Tight Yes )Jo psid Closed Tight Yes No psid Closed Tight _Yes No "y`: �� : ., :vr u' A � T � rte• �' �y r � T,t, . eislflr,Vacu "lgl;„ C 13 .�Qr. `•lit Rest, t,Va ti+>fzi'i airs , $ft,VU T(S' ;0401,1. .:... : a° Air'inlet Valve Check Valve Shutoff 42 Initial Test Failed to Ogen dyes r Na Closed Tight Yes No — — dosed Tight ..�Yes No Opened at___psid Pressure Drop Across Check Velvet/1_ psid Closed Tight Yes No Anal Test Opened at psidPressure Drop Across Check Valve 01 . •• psid Closed Tight ,._,Yes No Describe parts and repairs when needed: CERTIFICATION: thereby certify tile foregoing information provided by me to •' ••rest and that the teste de ce Is functioning in compliance with State of Minnesota Plumbing Code,Chapter4714. 1'1 TESTER'S SIGNATURE f TEST DATE: 08-24 Aug.25.2019 01:17 PM Interstate Testing 7637555365 #3296 P 15/19 Interstate Testing, LLC P.O. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT COMPLETE JOB ADDRESS(INCLUDE Apt/Unit 4) NAME OF BUILDING,OM/P./Eft/OCCUPANT,CONTACT NAME AND PHONE NUMBER 13575 58th St. N. Presbyterian Homes (Boutwell Landing) Dean Evenson (612)503-7498 Oak Park Heiahtsiy4N 55082 Dean ErverAprl APPLICANT COMPANY NAME CONTRACTOR(.)CENSE I% CONTACT NAME AND PHONE NUMBER Interstate Testing LLC PC75157 i.e, .i./ 7 7. 744-6 49 ADDRESS CITY STATE ZIP EMAIL P.O. Box 55 ;Anoka MN 55303 interstatetestinqAcorncast.net instER NAME TESTER CERTIFICATION P PHONE Donn Miller B=065323 (763)744-6149 TEST EQUIPMENT MANUFACTURER TEST EQUIPMENT MODEL 4 TEST EQUIPMENT SERIAL U TESTING EQUIPMENT CALIBRATION DATE Midwest Instruments 845-5 05090906 01-16-18 .' r - G1:.}may�7yy� /►y i,c�.{rte+:...:?.....1:-'.'''::•::+:-..: ,ppL,.y. - nfa l7} Y 2 ,�r.b .. `nry 4f • :FYPI`:;d 141Y1wAlY'J 'teI ,rtitin1Q 'V •`.. tty+AI) �.,;.� x F. .. Install Relocate Remove —Replace and SIU$of Replaced Device Rebuild X Test R r B4c1c. I-OWAS$ MBt YDAf'INF01.01 O0.,, , .:r.?R.:a.'.; ' ',..,..A. y` t Type(cheek one): Reduce Pressure Principal or Pressure 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:W l l kinS Modd# 975XL, seridl St 3055467 Size.,1-1 J2" (inches) system senAeed Irrigation Location'in bldg Lower Mech Room Floor Jt Roomst 60We' t , ''',!,:i .4,4;.,,,,;9.*),), TIE 5 5 -' 1F it ' �. . b�(Pt. k, l +!8b1�1`tt !t 34,- .l+�(� . 1, , Viz'. 0 t r f t 1# ' CRF' e n 1 -++. a r t .....':!. .,';::;4'',:} Check V®Ive 02 Shutoff Valve 42 Check Valve rem Pressure tkffeaentiul Relief Valve Initial Closed Tight L,Yes _No Closed Tight L,Yes w.-.No Closed Tight ._Yes. No Test Pressure Drop Across Check Valve m 9.8 Opened at 3,4 osid psid Final Closed Tight _Yes—No Closed Tight Yes _No Closed Tight Yes No Opened 3t psid Test Pressure Drop Across Check Valve ltd _psid `' :.' . r:.i,�14I;.: , .'c e; ted i8/III Ie:o_k 06,illiA ,Clit C Detect'Ci!-Oie PICotecttii :IDC}, `tESTRRESUtilt; ;:,,t;,k . + Check Valve rat Checit Valve#2 Shutoff Valve#2 Initial Test Closed Tight Yes No psid Closed Tight Yes No psid Closed Tight Yes No ( Final Test Closed Tight Yes No psid Closed Tight Yes ,No psid Closed Tight Yes No cQ , Kfti, ds•, .ri. 7TDur+ umPro O of mo "��kOt 0011ti `�:a1T� fit0 � 7 Et£SLt$ _�tii6'..?f4� ? Air Inlet Valve Check Valve Shutoff 42 Initial Test failed to Open _Yes No Closed Tight Yes �_No Closed Tight Yes No Opened at,,__,, ,psid Pressure Drop Across Check Valve 41 psid., Closed Telt YNo Final Test Opened at mid Pressure Drop Across Check Valve tit o_psid Tit Yes No I Describe parts and repairs when needed: .....67 f C CERTIFICATION: I hereby certify theforegoing Information provided by me to b rect and that the test ol9tice Is functioning in compliance with State of Minnesota Plumbing Code,Chapter4714. �t '✓�^"ti 0 `-- TESTER'S SIGNATURE TEST DATE:- - Sep.04.2019 03:10 PM Interstate Testing 7637555355 #3414 P 2/ 2 Interstate Testing, LLC P.O. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT COMPLETE JOB ADDRESS(tNCLuOE Apt/Unit i4 NAME OF BUILDING,OWNER/OCCUPANT,CONTACT NAME AND PHONE NUMBER 13575 58th St. N. Presbyterian Homes (Boutweil Landing) Dean Evenson (612) 503-7498 !-.. P. ..h : _ i-a .v-nso APPUCANT COMPANY NAME CONTRACTOR UCENSE iI CONTACT NAME AND PHONE NUMBER Interstate Testing, LLC PC751575 Dour Miller (763)744-6149 ADDRESS CITY STATE ZIP EMAIL P.O. Box 55 Anoka MN 55303 interstatetesting a(�comcast,net TESTER NAME TESTER CERTIFICATION# 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 , .'�.. � .., . j;,.7 r., ...,, y'. �.r, t, . .ir �\�R✓it.fir �.�.� r Inall Relocate _Remove _Replace and SN4 of Replaced Device +•_ Rebuild X Tet w. ti�Y� r �y t...,c clry fu I ''� �t►i41@ �Vt�'Ali+r`7F�W1A�a�'�' I A!!•,117C n C7 �iv.pn Type(cheek one): ,X,Reduce Pressure Principal or Pressure Principal Fire Protection , , Reduced Pressure Detector Fire Protection Double Check ValveDouble Check Detector Fire Protection _,...Pressure Vacuum Breaker_Spilt Resistant Pressure Vacuum Breaker Manufacturer:Wilkins Mockitt 975XL Serial# 3027$44 Size'3/4" (inches) system Servked Trash RinseLocation in bldg Main Floor, Garbage Area Floor x Main Room# G3rb°ge .��kd 7+ � ;:�i►i as l •.**0110.0040.t� P� L ' LYly,t1 't,1,1O` BEt.OW)` • �' a *x:a ' ^� Ridue ed P(e sur ndp.eI Ar l� uced.. s 'e D tectoi,F re ,ro #ctlaril'(RP). < '1'"I RESULTS Pressure Differentiae Check Valve#2 Shutoff Valve#2 Check Valve#1 Relief Valve Initial dosed Tight Z_yes _No Closed.Tight X Yes No dosed Tight I..-Yes„^„No Test Openedat4,Q psid Pressure Drop Across Check Valve tr1,7.5 psi d Final Closed Tight .,,,Yes.,._No Closed Tight Ycs No Closed Tight __.,Yes_No Opened at psid Test Pressure Drop Aaoss Check Valve 1C1, psid Check Valve tri Check Valve>:2 Shutoff Valve#2 Initial Test dosed Tight Yes No psid Closed Tight —Yes No psid Closed Tight Yes No final Test Closed Tight Yes No psid Closed Tight Yes No psid Dosed Tight Yes No 'R f� Pu ,self a � .. �ealcer ' 't11i i t Resistant�acu ft1:$t Kik r SR B -T;EST ' Air Inlet Valve Check Valve Shutoff#2 Initial Test Failed to Open ,Ye^, No Closed Tight �Ye s No Closed Tight Yes No Opened at,,:,,, jsid Pressure Drop Across Check Valve ll1 psid Final Test O Closed Tied' Yes _No opened at psid Pressure Drop Across Check Valve it1 „rsid Closed Tight Yes No Describe parts and repairs when needed: CERTIFICATION: I hereby certify the foregoing information provided by me to be and that the teste de 'ce is functioning in compliance with State of Minnesota Plumbing Code,Chapter 4714. p Jilt TESTER'S SIGNATURE TEST DATE: 09-04-1 9_. Aug.25.2019 01:18 PM Interstate Testing 7637555365 #3295 P 15/19 Interstate Testing, LLC PD. Box 55 Anoka, MN 55303 REGULATED BACKFLOW ASSEMBLY (RBA) APPLICATION FORM/TEST REPORT COMPLETE JOB ADDRESS INCLUDE Apt/Unit if) • NAME Of BUILDING,OWNER/OCCUPANT,CONTACT NAME AND PH E NUMBER 13575 58th St. N. Presbyterian Homes (Boutwell Landing) Dean Evenson (612) 503-7498 O k Park Heights, MN 55082 Dean Ev neon APPUCAMT COMPANY NAME CONTRACTOR UCENSE a CONTACT NAME AND PHONE NUMBER • Interstate Testing, LLC PC751575 ,D4nr Miller (76 )744-6149 ADDRESS CITY STATE ZIP EMAIL P.O. Box 55 Anoka MN 55303 ,interstatetesting[a�comcast.net TESTER NAME TESTER CERTWICATION tl PHONE Donn Miller B7065323 (763)744-6149 TEST EQUIPMENT MANUFACTURER I TEST EQUIPMENT MODEL 4 TEST EQUIPMENT SERIAL it TESTING EQUIPMENT CAUBRATION DATE Midwest instruments 1845-5 05090906 01-16-18 `.,r � F.-`ah 1 .. is w.._. ti ) ,_.r/�p��x rya. {.. >, ti ■ ';. .,;.,t �� : a ,av r f I'�., fPEOF�ii>t`LAND FEE INFOitMh1''iC)N chlechc.oil> _Install Relocate _Remove Replace and SAift of Replaced Device _Rebuild X Test Type(check one): Reduce Pressure Principal or Pressure Principal Firt Protection Reduced Pressure Detector Fire Protection __.Double Check VaseDouble Check Detector Fire Protection __.Pressure Vacuum BreakerSpill Resistant Pressure Vacuum Breaker Manufacturer;Wilkins Modelle 875XL serial x B082054 size: 1-1/2" (inches) System Serviced Location In bldg Lower Boiler Room Floor u Roomts 1.iST 440:4tS ]P Faafi V,(COMPt.fE<PP,P ►1IL E tY)rYPE Sl lO }xBE .O )-: Reds a.€ u 06, , +'714,°1 cdP essuYc cto`flr 40.;;c tfP).-T STR LILTS Check Valve#2 Shutoff Varve t12 Check Valve#1 Pressure Differential Relief Valve Initial Closed Tight _Yes d,...No Closed Tight Yes . No Closed Tight _Yes No Test Pressure Drop Across Check Valve 4I.9 Psid I Open ed at 322-135' .a- Ps Final Closed Tight_Yes,,.,,..No dosed Tight Yes �No Closed Tight _Yes No Opened at psid Test ! Pressure Drop Across Check Valve#1 psid IJI a rra t.,e,,,a,LL -`Doub a Chet k laht ,t)oubt +Check i ectot Fire Px of ct'`rdn(OC}-xTE iT t ESU ,. Check Valve III Check Valve Ir2 Shutoff Valve#2 Initial Test Closed Tight Yes No psid Closed Tight Yes No paid Closed Tight Yes No Anal Test Closed Tight Yes _No psid Closed Tight Yes No psid Closed Tight Yes No �;w 5�,��;'," �'. ,A� :�"•`�ESIPS � " >1�8��'� 006'061, V441444.7. � . 1° �1� 'Alot � .� .... . r r .. . ... Air Inlet Valve Check Vahre Shutoff IQ initial Test Failed to Open _Yes_No Closed Tight —Yes No Closed Tight Yes No Opened at ps3d Pressure Drop Across Check Valve 43_ psid Final Test Closed Tight _Yes _No Caned at Psid Pressure Orop Across Check Valve 41 „Psid Ttgfit . ._Yes No t Describe parts and repairs when needed: 1 CERTIFICATION: I hereby certiiyy t)teforegoing lrrformatton provided by me to be and that the tate d ce Is functioning in compliance with State of Minnesota Plumbing Code,Chapter 4714, p TESTER'S SIGNATURE ' . TEST GATE;0$124-19