HomeMy WebLinkAbout2003-06-13 St Paul Regional Water Services - Reduced Pressure Backflow Preventer Test Report REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: \)6-q-k!5, V Lto-.•.�,.- - o I Contact Person Tele I '
t�ddress: 14'$'6 0 )1 +i` 51- _ Al City: OAK t�Pk• 'S State: /AA Zip:.
Devic,.Location: y 11 t�-ut`pct_, Serve what system: t�w rL .1y-r j i rd-r e n
Account Number: Serial Number: ti S g 4 1
Tfpe: 'RP Z.— Make: W.4,,�1i.1. Model:cos Xl Size: ___,9....Li...
!jestaft Date: _-2.Date: Gao Installation Cate K C V •e--
Rebuild Date: t- Test Date: !e' ( 3— b-7-73
Check Valve#1 Check Valve 1..t2 Differential Pressure Relies Valve
An. mat
Report c�o < k CIO s� d-
Pressure _', .`# Pressure LQ .91 Opened at 3 :if asitl reduced pressure.
Old not open
Mewed Cleaned Cleaned
Realacad• Reptac'd Replaced
R Disc Disc Oise Upper
ESing
Guide
sPdn9 Disc-Lawes
Guice
*ming Reta�..r _ Pin Retainer Oiaphregm,L rge
1.P.
'tinge Pin t i iOe P n Lwwer
o
s431 Seat Upper
S Diaphragm
Oiapnragrn Oiaprvagm.Small
Other.C�=�nbe Other.dc`.criee Lower
Upper
h Ofd-. Seat
Lower
. Upper
Spacer.Lower
Other.de.vibe
[ 1 Sign and date Tag ! - j� IKL..k.A.A.1,_Theabove e;certified correct. Signed lC.i 0J.^"-- --- tJ_ 02teTested: L` 1 3< 3
1 Certification Number l u
Tested by(Print Name) • 'IP '' ` '
G.t.a-vi.i c.c C- • Licen92 Number o S _`1 P-
Company Name: �")' G0. ]<� M e , �1
Company Telephone Number (Q`.? ! ` -7 (o - 3 j
Alt sections of this report must be completed. Number of Devices Fee qer v+cp
Return to: Saint Paul Regional`Nater Services First
5 30
8 4th St E Ste 400 Devices 2-21 S 25
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