HomeMy WebLinkAbout2004-06-16 St Paul Regional Water Services - Reduced Pressure Backflow Preventer Test Report Jun 24 04 08: 44a P- 2
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: Vla S45 u.r Contact Person!//r'�ele////�� �—�►�-�
b % 5+ City: beak-Pk.. [f"1a State:A1- Zi
Address: 1 S -
Device Location: J Serve what system: iqw K (er( i Or-•
Account Number:
Serial Number: t j $a 3 1..
T,rte: lk p
Z Make:kA)Pro .5 Modet:(O 'f a r.
1Ts.. 11 Date: Air Gap Installation Date
Kabuki D2:e: Test Date:
Check Valve AlCheck Valve m2 Dif=ferential Pressure Reiier Valve
Annual
t
Pressure _te• PressureA. • p�
Report
Opened at 3-IP osid r�caducei!press:,:c.
p
Did not open
C:eanerl Cleaned
Deaner!
R.p.aaedReplaced Replacea
R ,1 Gisc Disc Disc,Upper
>/\
. Sgjg Suing Dtac. LewesGuideGuie� Spring
•
Pin RetainerPin F2e!ancr Oiaphrym.L^.r'e
Ninz Pin Lower
:-!:nge Pin
Seat Upper
R Seat -- Diaphragm.Small
p�.prr�m
Diaphragm --
S
Direr,describe Drier.dere�e Lown
Upper
h.0h'e Seat:
Lower
Upper
Spacer,Lower
Other.describe
Sign and date Tag
Oaterested:
The above is%er'af�ed�� Signed
`_ rCertification Nur..ocr 1 1�
Tested by(Print Vamp) v,l G r r r.r ~r) • _AA a.- 1 \
(1 ' 1 Int G. • License Nurnbet ras `- 7 P.
Company Nome: \"5 ea - )[ Ai E.ltun. C_
CcmparyTelephone Number &.c 'j t ` -7 ( -......,j_.3 -First —
Numger Of Devices Fier Oevice
M sections of this report must be completed. $er
Return to: Saint Paul Regional Water Services 30
Devices 2-21 S 25
8-nth St E Ste 400 1, 5nel nuc,r. C t
e 'd 84,9L-813t.- TSB IIapow dot. :LO t►0 Li unr