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Home My WebLink About2021-09-24 MMC Backflow Preveter Test Forms s 1 I • I MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive Eden Prairie,MN 55344 I 952-941-7010 I Address: City: Zip: i ;5815 Norell Avenue North Oak Park Heights ' 55082: I g Owner/Occupant: Building Name: • I IWalmart _Walmart#1861 _ j Description of Work: Date: Annual Test • _...._-- -_.. --.._.__._V `9 24 2021 _______ _ ._....-.' i z Contact Person: Contact Telephone: I MOD System Served: Device Location: Floor#: Room#: I Fire _..-._._.._._ _ :Fire riser room � First _.. :Fire- ._.._F w.u...... fMake: Model: Size: Serial#: I Ames ,_ 300055_._._........_.._ 8u ••137785 0205 (Test Date: Overhaul Date: Install Date: Previous Overhaul Date: ;9/2,4/2021___22 �^� _-® I : I INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Leaked _ .V_ PSi —_ ��_._._.._._ .._ ..� Leaked O None __� __._.m,� Pressure:DCV see notes =PSI 'Psi 0 Cleaned Test Passed:I NO TEST FAILED REPAIR NEEDED v Describe 'DCV ASSE 1015. Failed._ :,_ �� ~� _ ____ Repairs: • Final Test Check Valve#1 Relief Pressure _— Check Valve#2 ^_.__._.._.._....__ 0 CLOSED!– ._._..,.....,.-,....__.-_ __Psi 0 CLOSED Pressure:! _ PSI �� __ _.__...___ _.PSI 1 Test Performed By: Certification Number: Chris Lewis ___ ____ BF 065677_ Metropolitan Mechanical Contractors �� _ ._;7450 Flying Cloud Drive —._.._•_,w.._.. – ^– Phone:952-941-7010 Eden Prairie,MN 55345 : • . i MMC BACKFLOW PREVENTER TEST FORM • Y 7450 Flying Cloud Drive i Eden Prairie,MN 55344 , 952-941-7010 1 Address: City: Zip: y5815 Norell Avenue North Oak Park Heights 55082 _ Owner/Occupant: Building Name: V 11Walmart . Waimart#1861 Description of Work: Date: Annual Test M ______.______.�______.—_�_` 9/24/2021____.__M ._� IContact Person: Contact Telephone: I IMOD .. _ �___ __� _ • I System Served: Device Location: Floor#: Room#: !'Domestic water serv... 'water room First ' Water room 1 Make: Model: Size: Serial#: .____ Watts : :909 3„ _ __..._. __ _-_- ____� . -__.-______..__ .,__,w._� __ __ 179856 a Test Date:_ _ Overhaul Dote: ~ ��^_-__Install Date: Previous Overhaul Date: `;9/24/2021 .. - ._..,. � Imm _ __. �. .-._. i 1 INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Closed v 1 PSI Closed v 0 None Pressure: 5 .. ____PSI Tiht PSI 0 Cleaned _._-._-___-__-..__-__.___.__..__ I Test Passed: YES SUBMIT AS FINAL v Describe IASSE 1013 RP. 1 Repairs: v I Final Test Check Valve#1 Relief Pressure Check Valve#2 f 0 CLOSED MPSI 0 CLOSED Pressure: --w✓-_..._ --_-_—. -- ___ �._«___. i __.._.._._.._..__.._..._ PSI '-______________ __PSI__ k 1 Test Performed By: Certification Number: I Chris Lewis BF 065677 _____..«-�� IMetropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 r li i` • •• MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive } Eden Prairie,MN 55344 952-941-7010 Address: City: Zip: I ':5815 Nord!Avenue North • Oak Park Heights 55082 - Owner/Occupant: __.,._ �_._._–_ Building Name: Waimart Walmart#1861 Description of Work: Date: liA Annual Test %':"9/24/2021 �___— n. I Contact Person: Contact Telephone: IMOD j System Served: Device Location: Floor#: Room#: ;Fire detectorw : Fire riser First LFire •riser oom Make: "� Model: Size: Serial#: i'Ames 200D8 13/4° _ ._ __ 141196 - 1 Test Date: uH Overhaul Date: M~ Install Date: ' Previous Overhaul Date: •INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer l `Closed NONEClosed y v 1 �_�___—_..____...�. __ r _ PSI D None IPressure:;DCV see notes 1.6 psi :2.0 PSI 0 Cleaned i Test Passed: YES SUBMIT AS FINAL v Describe ASSE 1015 DVA-Shutoff#2 closed tight. CV#closed tight with 1.6 PSID. I Repairs:1CV#2 closed tight with 2.0 PSID. 1 Final Test Check Valve#1 Relief Pressure Check Valve#2 i ❑CLOSED --.__----__ -.......__ _.-._-_.....�.._.�.__.__ _,PSI ❑CLOSED Pressure:' r--------- + 'PSI PSI l Test Performed By: Certification Number: I Chris Lewis : BF 065677 — I Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 i I ti i i MMC BACKFLOW PREVENTER TEST FORM i i 7450 Flying Cloud Drive Eden Prairie,MN 55344 1 952-941-7010 4 f Address: M__ __. City: __ Zip: ;5815 Norell Avenue North __ _m. __ 'Oak Park Heights- ;55082 Owner/Occupant:____._rkw..__- _�,.. -. ��. .a Building Name-�� - . _- -� i Walmart ------._._�.____ Walmart#1861 __ I Description of Work: Date: _ •Annual Test v 9/24/2021 i i Contact Person: Contact Telephone: ;MOD -. System Served: Device Location: Floor#: Room#: [!Chemical feed ,janitors'sink in back le... ;First Back Left of store Make: __. Model: _ ___ __�Size: Serial# 'Watts SOt?M ':B/4�� - -:;403973-. i___ ._.-_ __. ___..__...._...._..._..._.__ _- _ _ .. .. _ • ITest Date: Overhaul Date: Install Date: Previous Overhaul Date: i INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Closedv- - -._._.... 1.6 Air inlet Psi Select... ��': ❑None • I Pressure: PVB see notes 2.2 None PSI Cleaned ___..___._......;PSI : Test Passed:;YES SUBMIT AS ANAL _ __v. I Describe ASSE 1020 PVB-Shutoff#2 tight. CV closed with 2.2PSID. Air inlet opened with 1.6PSID 1 Repairs: i I Final Test Check Valve#1 Relief Pressure Check Valve#2 G I 0 CLOSED �__ ---___ PSI 0 CLOSED ----- v I Pressure:. ' : -__--.____.._._PSI PSI I !Test By: Certification Number: I;Chris Lewis BF 065677 Metropolitan Mechanical Contractors 7450 Flying Cloud Drive I Phone:952-941-7010 Eden Prairie,MN 55345 • {'r MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive Eden Prairie,MN 55344 1 952-941-7010 i •!Address: Address: �__._ __. — •City: Zip: • '5815 Norell Avenue North _ ~ Oak Park Heights 55082 �� Owner/Occupant: w — ___. .. _ _ ___.___�_�...`Building Name: -_ _ �_ I Walmart 'Walmart#1861 i Description of Work: I,__ ____.._—.__.... Date: Annual Test v '9/24/2021 __'9/24/2021 Contact Person: Contact Telephone: IMOD m.,,. - !System Served: Device Location: Floor#: Room#: IRO Produce !First ProduceMLL___.._..__.__.___.,. Make: Model: Size: Serial#: __ Watts .___ . _ 800M4 3/4" __ `044351 ___ _ Test Date: Overhaul Date: Install Date: _ Previous Overhaul Date: ;9/24/2021 IINITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Leaked vPSI :Select... Y D None Pressure:;PVB see notes —— ___.____._ :._._.,.,____.._._.__.____._. ;PSI PSI O Cleaned Test Passed: NO TEST FAILED REPAIR NEEDED v' ASSE 1020 PVB-Failed._-- _._.__... ...,__ _ .. _'_ ---___.�__,_...-_ ..-_._.._,,...aF,-.,....—. Describe Repairs: Final Test Check Valve#1 Relief Pressure Check Valve#2 0 CLOSED -- �,,,,_____-_:PSI 0 CLOSED Pressure:. ' • PSI PSI • I Test Performed By: Certification Number: 1 Chris Lewis BF 065677 Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 • = fi • • • MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive Eden Prairie,MN 55344 • 952-941-7010 .1111 I Address: —,__...__—___ City: ___ Zip: 1'5815 Norell Avenue North Oak Park Heights 155082_ I Owner/Occupant: Building Name: ;Walmart _— _ _ _._._.._-----.. __ _.. �Walmart#1861 M r Description of Work: Date: _ , Annual Test v 9/24/2021 I Contact Person: 1 Contact Telephone: ii MOD System Served: Device Location: Floor#: Room#: ! Chemical feed ; Janitors'station in Meat :First Meat i Make: Model: Size: Serial#: ___ ________.. _ I iFebco 765 3/4" 96559: f Test Date`- Overhaul Date: _ Install Date: — — Previous Overhaul Date: 19/24/2021 ____® taF • INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Closed !_.- __ .._.____. .,._____„„_psi Select. __ _ . - '. 0 None Pressure:;PVB see notes Failed psi 4 PSI Cleaned € Test Passed:iNOTEST FAILED REPAIR NEEDED v I Describe ASSE 1020 PVB-Failed. ! t Repairs: 1 Final Test Check Valve#1 Relief Pressure Check Valve#2 i 0 CLOSED • PSI 0 CLOSED I Pressure: 'PSI i PSI I Test Performed By: Certification Number: Khris Lewis 3BF 065677 I Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 i !! i: 1 i MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive f Eden Prairie,MN 55344 • 952-941-7010 •=Address: City: _ Zip: • 15815 Nord!Avenue North : Oak Park Heights ;55082 — 1 Owner/Occupant Building Name: ' ''Walmart -- .•-,_.-_._________._...- iWalmart#1861 ._._. __ __...w.� _ Description of Work: Date: Annual Test v 9/24/2021 I i Contact Person: Contact Telephone: ':MOD ISystem Served: _ — Device Location: Floor#: Room#: Chemical feed i lanitors'sink in Produce ' First — !Produce Make: Model: Size: Serial#: `Waits_ —V 800M4 _ _ 3/4" — ;044435 _ __ Test Date:�. y Overhaul Date: _ Install Date: M Previous Overhaul Date 9/24j2021 _.gm ® El 1 INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer cClosed W — ,e i2.8 Air inlet Psl $elegy... _`! ❑None • • IPressure: PVB see notes 2.2 PSI None PSI 0 Cleaned i I Test Passed: YES SUBMIT AS FINAL v 3 Describe[ASSE 1020 PVB-Shutoff#2 tight. CV closed with 2.2PSID. Air inlet opened with 2.8PSID i Repairs:!. I Final Test Check Valve#1 Relief Pressure Check Valve#2 0 CLOSED psi 0 CLOSED Pressure:i :PSI ( Psi I Test Performed By: Certification Number: •• IChris Lewis = BF 065677 i Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 i • MMC BACKFLOW PREVENTER TEST FORM • 7450 Flying Cloud Drive • Eden Prairie,MN 55344 952-941-7010 1 I Address: _ City: _ Zip: 1158.15 Norell Avenue North -- Oak Park Heights `55082 1 Owner/Occupant: Building Name: � _.._. I WO/mart Walmart#1861 - Description of Work: ..,._.__.,,_.___.-.-.--__.--Date: —._-_- -__-..�__.______. -._..,__.___ -.,.,.._�. — ;Annual Test v 9/24/2021 I Contact Person: Contact Telephone: MOD System Served: Device Location: Floor#: Room#: IChemical feed Janitors'sink in Bakery ;First « � ^« _____.__ :Bakery__ ..... _ ___« Make: Model: Size: Serial#: E l;Watts_ _ 1800M4 _ '3/4"-------------- �_ ;0442_4_8_ _ r Test Date: �_ Overhaul Date:__ _�.,-. —, Install Date: __«__^ -- Previous Overhaul Date:-_ ;'9/24/2021 ....- ._ 0 _..__ .31 1 INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer ! Closed 2.8 Air inlet PSI Select... 0 None 1 Pressure:'PVB see notes 3.0 ;PSI :None pSi 0 Cleaned Test Passed:;YES SUBMIT AS FINAL ., i Describe jASSE 1020 PVB-Shutoff#2 tight. CV closed with 3.0PSID_ Air inlet opened with 2.8PSID I Repairs: I Final Test Check Valve#1 Relief Pressure W Check Valve#2 = 0 CLOSED psi 0 CLOSED Pressure: __._..... ......,..._..__---.......__.;PSI I _ PSi i Test Performed By: Certification Number: f Chris Lewis _,N..._ EBF 065677 w.. - Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive 9 Eden Prairie,MN 55344 1 952-941-7010 i r I Address: City: ___,. Zip: 5815 Norell Avenue North 1 =Oak Park Heights_ j;55082 Owner/Occupant: BuildingNa _ - - me: 1 Walmart Walmart#1861 ---_, E Description of Work: Date: i Annual Test __ N'.�N', :9/24/2021 M Contact Person: Contact Tele phone: IMOD System Served: Device Location: Floor#: Room#: Dishwasher _ ;Bakery ?First �` :Bakery I Make: Model: — Size: Serial#: 1 tWatts 008PC _. _ _ _ 1/2" _ _ Previous ,_32860 f Test Date: Overhaul Date: Install Date: _ Previous Overhaul Date:_ 119/24/2021 _ _ __ _'� _.0 I 1 INITJAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Leaked ._.psl Select... �' ❑None „__... _._..__._.. _.�.,_�__...._._.._.. Pressure:':SVB see notes-Failed jpSl ;PSI 0 Cleaned Test Passed:I NO TEST FAILED REPAIR NEEDED v DescribeASSE 1056 SVB- Repairs: Failed • Final Test Check Valve#1 Relief Pressure Check Valve#2 0 CLOSED .PSI 0 CLOSED Pressure: PSI PSI 1 Test Performed By: Certification Number: I Chris Lewis BF 065677 is • Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 • MMC BACKFLOW PREVENTER TEST FORM 7450 Flying Cloud Drive Eden Prairie,MN 55344 952-941-7010 • I Address: City: Zip: M_..._ -------- 5815 Norel/Avenue North Park "- 1_______ ...___ Oa_k Heights 55082: • I Owner/Occupant: ��__....w _._._- Building Name:______-�._� „,� � ;Wolman i Walmart#1861 __ _.__ _ Description of Work: ____r�_.._....:Date:�...�...._..._.�.._.,...,._.— _�____ �,.,_..,_„�,,... .._� 1 i Annual Test v '9/24/2021 I • IiContactPerson: Contact Telephone: !IMOD • i System Served: Device Location: Floor#: Room#: i'Chemical feed lanitors'station in Deli First Deli: Make: Model: Size: Serial#: ~ 'Watts �.. 800M4 _, __ 3/4�� ______I ;044320 Test Date: Overhaul Date: m Install Date: Previous Overhaul Date: — i • INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer z Closed __ v 1.8 Air inlet PSl Select.,. v O None • I Pressure: PVB see notes 2.8 i _ PSI None PSI 0 Cleaned TestPassed:'YES SUBMITAS FINAL —_____�___._, ___ _ v„ Describe!ASSE 1020 PVB-Shutoff#2 tight. CV closed with 2.8PSID. Air inlet opened with 1.8PSID lRepairs: • Final Test Check Valve#1 Relief Pressure Check Valve#2_________.—, 2.____. ____...W., i {' 0 CLOSED �� `_ .PSI 0 CLOSED Pressure: ___.._...r_ _._ _._ _ _._______....__ _ s ` ;PSI 'PSI 1 Test Performed By: Certification Number: I:Chris Lewis BF 065677 Metropolitan Mechanical Contractors 7450 Flying Cloud Drive i Phone:952-941-7010 Eden Prairie,MN 55345 i I I MMC BACKFLOW PREVENTER TEST FORM f / 7450 Flying Cloud Drive I Eden Prairie,MN 55344 952-941-7010 • I I I I 1 Address: City: Zip: C5815 Nord!Avenue North -- Oak Park Heights 155082 Owner/Occupant: Building Name: i Walmart Walmart#1861 I Description of Work: Date: El :AAnnual Test — .w .._.,..-_,._...._____--_.._. "` :9/24/2021 _._..____ 4 Contact Person: Contact Telephone: MOD 1 System Served: Device Location: Floor#: Room#: l Chemical feed Janitors'sink in middle... ;' _ !Entrance — Make: Model: V� ` Size: – —� ��_Serial#: — --v l Watts _Ii 1800M4 3/4" i 405492 Test Date: Overhaul Date: Install Date: Previous Overhaul Date: INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Closed v 1.6 air inlet Psi Select... " D None Pressure: PVB see notes 2.8 psi None _ _–_ MPSI 0 Cleaned Test Passed: YES SUBMIT AS FINAL " . Describe iASSE 1020 PVB-Shutoff#2 tight. CV closed with 2.8PSID. Air inlet opened with 1.6PSID Repairs:I Final Test Check Valve#1 Relief Pressure Check Valve#2 . 0 CLOSED psi 0 CLOSED M PressurePSI PSI t Test Performed By: _ Certification Number: ::Chris Lewis BF 065677 Metropolitan Mechanical Contractors 7450 Flying Cloud Drive I Phone:952-941-7010 Eden Prairie,MN 55345 I •ii MMC BACKFLOW PREVENTER TEST FORM •7450 Flying Cloud Drive Eden Prairie,MN 55344 I 952-941-7010 a i E iAddress: City: _ Zip: 15815 Norell Avenue North __.,_ -..w_.__._. _ 'Oak Park Heights v__ � 55082 - _. _ IOwner/Occupant: Building Name: `Walmart ' !Walmart#1861 i Description of Work: Date: Annual Test v 9/24/2021 DE '� i i I Contact Person: Contact Telephone: I MOD System Served: v— I Device Location: u... ._ Floor#: Room#: eyewash . ,..m2,;Automotive Center lower level Automotive3 Make: Model: Size: Serial it Watts 008PCQT : ,3/4" Test Date: Overhaul Date: Install Date: Previous Overhaul Date: 9/24/2021 til E ta -17• INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer Closed ' 3.0 Air inlet psi Select... `' 0 None Pressure:ISVB see notes 5.0 :psi psi 0 Cleaned Test Passed:!YES SUBMIT AS FINAL v Describe IASSE 1056 SVB-CV closed with 5.0 PSID. Air inlet opened with 3.0 PSID. Repairs: Final Test Check Valve#1 Relief Pressure Check Valve#2 0 CLOSED psi 0 CLOSED � Pressure:jPSI PSI { Test Performed By: Certification Number: _..,...._. ____.____ tChris Lewis w BF 065677 ; Metropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 i I: (: 1 i • MMC BACKFLOW PREVENTER TEST FORM 17450 Flying Cloud Drive i Eden Prairie,MN 55344 I 952-941-7010 i I Address: _� City: Zip: 1 5815 Nor d'Avenue North :Oak Park Heights _...._ ______._ I�--------... j 550$2 ..� Owner/Occupant: — _..____ _v_______....._ Building Name: ry„ — t`WaImart1 Walmart#1861 1 Description of Work: Date: _.___ Annual Test _„ __ !9/24/2021 �_ ,_ i IContact Person: Contact Telephone: € MOD I System Served: _ Device Location: Floor#: Room#: i FIrrigation 'Garden center First Garden center Make: — 4�- Model: Size: �Serial#: - I ;_Wilkins _ 9_75XL __ '2” _ ;037127 _ Test Date: -� Overhaul Date: _ _ Install Date: ��____ Previous Overhaul Date: 1 . :'9/24/2021 :'.__ '� INITIAL TEST Check Valve#1 Relief Pressure Check Valve#2 Strainer 1 f ;Closed ---_-�• 4.0 ..—�____._..,.-__...,_. Closed � PSI ❑None Pressure: 8.2 ( :__...___.-._-_--.___.__._.._._.._...__..;PSI Tight !Psi 0 Cleaned ' Test Passed: YES •SUBMIT AS FINAL v : DescribeASSE 1013 RP ___...___,._..,._ Repairs: Final Test Check Valve#1 Relief Pressure Check Valve#2 s _ _ 0 CLOSED _— __ ___—MPSI 0 CLOSED 1 Pressure:i ;RSI ! PSI • Test Performed By: Certification Number: Chris Lewis ��- F 065677 ------- B IMetropolitan Mechanical Contractors 7450 Flying Cloud Drive Phone:952-941-7010 Eden Prairie,MN 55345 1 P 1 42 Insert item 1MMC RPZ TEST FORM r..M.__......_..____. I