HomeMy WebLinkAbout2005-06-07 St Paul Regional Water Services - Reduced Pressure Backflow Preventer Test Report 06/20/2005 20: 48 6512289201 ST PAUL PLUMB;* PAGE 02
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: _ /ler ..ge .z. 4 j/_ Contact Person/Tele —.
______________
Address: r
y' t//E City: 04�i9�ek J State:e Zi
iZ e
Device Location: eA4,1,y7.-.1 Serve what system: SROs ,t fr.f ege"..,
Account Number_ ,. Serial Number:• 101,3L
Type --� Make: L'/ f_ Model: ,OC� lL
Size:
Install Date: _ Air Gap Installation Date
Rebuild Date: Test Date: ,��[_`, j_6 —
Annual Check Valve #1 Check Valve#2 Differential Pressure Relief Valve
Report s
Pressure -7s/ Pressure Opened at 3'
P sed reduced pressure.
Did not open
Cleaned Cleaned Cleaned
Replaced Replaced
R Disc Replaced
Disc� `
E Spring Spring Disc, Upper
P Guide Disc, Lower
Guide
A Spring
Pin Retainer ' Pin Retainer
Diaphragm, large
Hinge Pin ^_ Hinge Pin
lower
R .._ Seat Seat
�— Upper
S �_ Diaphragm _, _ Diaphragm _ Diaphragm, Small
• — Other,describe Other, describe
_ ._--_-_— Lower
Upper •
. Seat:
— _ Lower
Upper
Spacer, Lower
1----------
- ,� Other,describe i
L � Sign and dale Tag ..__.._
�
The above is certified correct. Signed ."....: I I
r 1� _V__ `
V/ r / Date7ested;_ f� �"
Tested by (Print Name) ' I
/� 4114 - Certification Number i
Company Name: 'G ...119416-
------: • N License Number
Company Telephone Number �7�� 1 � �
All sections of this report n,usl be completed. -_.
Number of Dcvjcegi
Return to: Saint Paul Regional WFirst
aler Services $30 FES perDevice
8 4th Si E Ste 400 I
• Devices 2-21
Saint Paul. MN 55101-1007 $2$
2?. and over
$ 15 i