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Home My WebLink About2020-01-14 Fire Construction Servcies RPZ Testing Report ...... Fire Construction Services i + 888-701-3473 Attl Q� 4''A Pki thefiregroupinc.com � -51 da FCS, (xr LLC Business Contact Person.1.4___H Date S 7L 'Gds I—/y—249 Address City Zip 5-6 a s- Ktut‘_cl-4,-/2-- Cx -g- - -s� 4z°CK2 �� 1� ASSEMBLY INFORMATION(All Fields are Required) System Served Make Model Size Serial Number - wf'` --/ z_. q 75- k _ / " /6 y8b�j© 7.-u Location of D ce System Served (7,------PRESSUR PRINCIPLE BACKFLOW PREVENTER (RPZ) -TEST RESULTS Shit Off Valve#2 Check Valve 111 Pressure Differential Check Valve#2 6rRelief Valve ff�-��JJClosed Tight: Closed Tight: Opened At: Closed Tight:YES f29 NO( ) Annual l' '''.--- 2.YES( NO( ) YES('�-)NO( ) `oma psid 737.4?/— Jr / psid fk psid DOUBLE CHECK BACKFLOW PREVENTION ASSEMBLY(DC)-TEST RESULTS Shut Off Valve#2 Check Valve 41 Check Valve#2 Closed Tight: Closed Tight: Closed Tight: Annual Test YES( )NO( ) YES( )NO( ) YES( )NO( ) psid psid PRESSURE VACUUM BREAKER ASSEMBLY(PVB) -TEST RESULTS Shut Off Valve#2 Check Valve#1 Air Inlet Closed Tight: Closed Tight: Opened At:, _ _ psid Annual Test YES( )NO( ) YES( )NO( ) psid SPILL RESISTANT VACUUM BREAKER (SRVB) -TEST RESULTS Check Valve#1 Air Inlet Closed Tight: Opened At: Annual Test YES( )NO( ) — —psid psid CERTIFICATION:I certify the forgoing information provided by me to b orrect an. that the tested device is functioning with in the limits of the Standards Name: Steven Hinson g Date:L.-- / --2.1)0 v Signature: State of MN Certification Number: Steve Hinson-Certification#BT753310 This report is for the purpose of recording only; Owner is responsible for safe operation and upkeep of scheduled maintenance. t !: L!- Fire Construction Services j rx: 888-701-3473 4:11din thefiregroupinc.com I,i FCS LLC Business Contact Person Date Address ilillrill.1111111111City Zip — 6iii; o . /Luc /ijL / - c�� f*rte. / /F '-f Cr()8 L BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served Make Model Size Serial Number J/0,M Ti ci rij . '"z_t,,." Ills }K 1_, 2 1, 1 F82-?3 Location of Device \ System Served PR E PRINCIPLE BACKFLOW PREVENTER (RPZ) -TEST RESULTS Stl t Off Valve#2 Check Valve#1 Pressure Differential Check Valve#2 Relief Valve Closed Tight: Closed`TTight: Opened Al: Closed Tight:YES j3(')NO( ) Ann rt YES NO( ) YES( CNC( ) _ 8 psid �'' z psid 7- &-t Psid DOUBLE CHECK BACKFLOW PREVENTION ASSEMBLY(DC) -TEST RESULTS Shut Off Valve#2 Check Valve#1 Check Valve 1/2 Closed Tight: Closed Tight: Closed Tight: Annual Test YES( )NO( ) YES( )NO( ) YES( )NO( ) psid psid PRESSURE VACUUM BREAKER ASSEMBLY (PVB) -TEST RESULTS Shut Off Valve#2 Check Valve#1 Air Inlet Closed Tight: Closed Tight: Opened At: psid Annual Test YES( )NO( ) YES( )NO( ) psid SPILL RESISTANT VACUUM BREAKER (SRVB)-TEST RESULTS Check Valve#1 Air Inlet Closed Tight: Opened At: Annual Test YES( )NO( ) psid psid , CERTIFICATION:I certify the forgoing information provided by me to be c•J ect:nd t tested device is functioning with in the limits of the Standards / Name: StevenHinson Signature:_ ' .,1T• ._// Date: Zt/ l�tl — — State of MN Certification Number: Steve Hinson-Ce ification#=�5 310 This report is for the purpose of recording only; Owner is responsible for safe operation and upkeep of scheduled maintenance.