HomeMy WebLinkAbout2001-06-22 St Paul Regional Water Services - Reduced Pressure Backflow Preventer Test Report REDUCED PRESSE BACKFLOW PREVENTER TEST-E- .PORT AND
ESTASLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
arvice Name: brkk Contact Perrsonaele £t''M TCS+ler to 5 1 ." 4 -- S g 65
ddress: �e6`61 0 5-1+1^ s+. n[ . City. O _ Pk. 14-1-5 State: Q2�Y Zip:
evice Location: in CIo91,au5e A "> Serve what system: 1a # r ivy i aj.i Low,
ccount Number: Serial Number. 4514 l J
'Ype: Q7Z:„ _ _ Wake: Lt)`'I,ki'r►,5 _ modes:9'74-`41---Vac4t-1•'
'stall Date: .5 - 1 v ca...0 o O Air Gap Installation Date As -I 0 - 0 0 a
ebuiid Date: ,5- - Le) - a.o o A-- Test Date: .5-'— ( 0 — ..1-o O 0
Arcual Check Valve#1 Check Valve#2 Differential Pressure Relief Valve
Report
Pressure ' •$ Pressure 7 -9 _ Opened atmid reduced pressure.
Did not open
XCleaned Cleaned Cleaned
Replaced X Replaceda
•
R __X.:„;.__, Disc Disc ti
pper
E �_ Sprung ung Dice,Lower
P Guide Guide
Spring
A Pin Retainer Pin Retainer Oiaphragrn.Large
t Hinge Pin Hinge Pin Lower
R )c Seat Seat Upper
5. Diaphragm! Diaphragm U►ephragm,Small
Other,describe - Other,describe Lower
Convla.t e tek- Seat Upper
c55•P D Lower
Upper
Spacer,Lower
Nd wt..Other.describe
L X I Sign and date Tag
The above is certified correct. Signed bv O`"' g' 010 • DateTested: 4, —021a—d
TP ted by(Print Name) ti3 4„y'C'e ry ( - off r_I l Certification Number 9. 3 or
Company Name: k4i e c Llr\Lc.L / 1 r\C.. • ' License Number 1 9 41a
Company Telephone Number (o...5". I -- 7 g 6 --.3575-1-
Ail
-.35ccAil'sections of this report must be completed. Number of Aevices Foe per_Device
Return to: Saint Paul Regional Water Services First $ 30
8 4th St E Ste 400 Devices 2-21 $25
Saint Paul, MN 55101-1007 22 and over $ 15