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Home My WebLink About2020-09-01 Backflow Preventor (RPZ) Test Reports - NAC Mechanical ,ck .....) ,,,,,z. c 6. BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDEAD KESS#,STREET NAME,&DIRECTI NAL),Apt/Unit# 4 ( 6 -6 Oak RA,4. 13 i 04 k ea [1.Q(cdti, BACKFLOW ASSEMBLY INFORMATION(All Fields ar equired) System Served: (--I CO( 40 of Assembly: Model# 06I. 11/3 Size of Assembly: 3/7 iSerial# 7) SI V Location of Assembly: Floor# —( Room# /11 ec_ Date test was performed: Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tigh YesDNo Closed Tight4 Yes II. Closed Tigh Yes=No initial Test Pressure Drop A os' Opened at ii•_c _psid Check Valve#11,_09, psid Describe parts and repairs when needed Closed Tight Yes No Closed Tight _Yes No Closed Tight Yes No Final Test — Pressure Drop Across Opened at psid Check Valve#1 psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight'_fres E=INo Closed Tight O Yes r'o Initial Test Closed Tight 0 Yes 1:1No psid psid Describe parts and repairs when needed Closed Tight) ,..,.,,..,,fres No Closed Tight=Yes=No Closed Tight❑Yes=No Final Test — psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Ope=Ye=No Closed Tight ❑ Yes Milo Closed Tight Q Yesallo Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight I-Nes CNo Final Test Opened at_ psid Pressure Drop Across Closed Tight YeLl_No Check Valve#1__ ___ ,psid er CERTIFICATION:I certify the foregoing information provided by me to be correct a that th ste evice is functioning with the limits of the standards Name(Print):MARK GYORGAK signature: A,/ , Date: c -_-1,• _-_-- a BF084096 State of MN Certificate Number: _.- e7:2\ --)C BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE ADDRESS#,STREET NAME,&DIRECTIONAL),Apt/Unit# 1 4 16 7,) k to� er.50( BACKFLOW ASSEMBLY INFORMATION(AR Fields are Required) r, System Served: lift t' (c t/l Manufacturer of Assembly: 14-44. Model# OC( /`'l Rtk {{{ Size of Assembly; ,(11 ttt Serial# 3-i t Location of Assembly: Floor# Room# Date test was performed: 1 7)6, Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight d1.4:1 Yes QVo Initial Test Closed Tight. Yesallo Closed Tight Yes IINo Pressure Drop Across Opened at / , f psid Check Valve#1 ) psid Describe parts and repairs when needed Closed Tight Yes No Closed Tight Yes No Closed Tight -Yes No Final Test Pressure Drop Across Opened at psid Check Valve#1 psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tights _Nes I=No Closed Tight t=I Yes=No Closed Tight ElYes ONo Initial Test psid psid, Describe parts and repairs when needed Closed Tightl'es=3No Closed Tight®Yes=No Final Test Closed Tight 0 Yes ONo psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker SRVB)-TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Opel=)YeJ No Closed Tight n Yes Elo Initial Test Pressure Drop Across Closed Tight Yen No Opened at psid Check Valve#1 ,psid Describe parts and repairs when needed Closed Tight I_h'es L Vo Final Test Opened at psid Pressure Drop Across Closed Tight YesE[No Check Valve#1 psid CERTIFICATION:I certify the foregoing information provided by me to be correct and that the t ted device is functioning with the limits of the standards. Name(Print):MARK GYORGAK Signature: Date: State of MN Certificate Number: BF084096 V � (750 BACKFLOW PREVENTER TEST REPORT JOB ADDRESS(INCLUDE AD KESS#,STREET NAME,&DIRECTIONAL), pt/Unit# (thkr6 / iI O4 5 A fi BACKFLOW ASSEMBLY INFORMATION(All Fields are Required) System Served: ((/rrt p j.t �� Manufacturer of Assembly: -^i- Model# d Size oft Assembly: Serial# }1 °3 ZSc( tt Location of Assembly: Floor# Room# Date test was performed: 71 JQU Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS Check Valve#2 Shutoff Valve#2 Check Valve#1 Pressure Differential Relief Valve Closed Tight Yes o Initial Test Closed Tig�it ®YesDNo Closed Tight Yes IINo Pressure Drop Rcrpss{ Opened at?�L`(/ psid Check Valve#1 Cis • / psid t Describe parts and repairs when needed Closed Tight __Yes No Closed Tight Yes No Closed Tight Yes No Final Test __ — Pressure Drop Across Opened at _psid Check Valve#1 ._ psid Double Check Backflow Prevention Assembly(DC)—TEST RESULTS Check Valve#1 Check Valve#2 Shutoff Valve#2 Closed Tight) kes=No Closed Tight l r Yes r T o Closed Tight11:1 Yes No Initial Test psid psid Describe parts and repairs when needed Closed Tight=fes 1=1No Closed Tight 0 Yes Vo Closed Tight Yes E3No Final Test psid psid Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS Air Inlet Valve Check Valve Shutoff#2 Failed to Opek....___NeJ No Closed Tight 0 Yes Cato Closed Tight 7YesE_No Initial Test Pressure Drop Across Opened at psid Check Valve#1 psid Describe parts and repairs when needed Closed Tight =es =No Closed T'ght El YesElNo Final Test Opened at psid Pressure Drop Across Check Valve#1__ ,_psid CERTIFICATION:I certify the foregoing information provided by me to be correct and thatatthe tested device is functioning with the limits of the standards. Name(Print): MARK GYORGAK Signature: �2% Date: It State of MN Certificate Number: BF084096