Loading...
HomeMy WebLinkAbout2006-04-27 Mid City Mechanical RPZ Annual Test Report ANNUAL TEST REPORT .� REDUCE. RESSURE ZONE BACKFLOW PI IENTERS DOUBLE CHECK VALVE ASSEMBLIES MANUFACTURER Wilkins MODEL 975XL SIZE 3/4" SERIAL# W215041 NAME OF FACILITY Valvoline Instant Oil COUNTY Washington ADDRESS (STREET, CITY,ZIP) 5965 Osgood Ave., Oak Park Heights, MN Store#28 LOCATION OF DEVICE IN BUILDING Lower Level, West Wall CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) 3. H INITIAL LEAKED ( ),.-I„EAKED ( ) ham, OPENED AT PSI TEST CLOSED TIGHT (/) CLOSED TIGHT (p ' REDUCED PRESSURE DID NOT OPEN ( ) 7� DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC. ASSEMBLY ( ) DISC HOLDER ( ) DISC HOLDER ( ) 0-RINGS ( ) STEM ( ) STEM ( ) STEM ( ) RETAINER ( ) RETAINER ( ) SPRING ( ) 0-RINGS ( ) 0-RINGS ( ) DIAPHRAGM ( ) SEAT ( ) SEAT ( ) SEAT ( ) SPRING ( ) SPRING ( ) SPACER ( ) GUIDE ( ) GUIDE ( ) OTHER--- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER-- ( ) OTHER-- ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: FINAL CLOSED TIGHT ( ) CLOSED TIGHT ( ) OPENED AT PSI TEST REDUCED PRESSURE INITIAL TEST BY o4 Z t lc-c F-4-ci T s c: 1,‘ DATE -l-),,)6., SIGNATURE-7'4n2 -2' REPAIRED BY DATE SIGNATURE FINAL TEST BY: MID-CITY MECHANICAL DATE 4-1'2:771-% SIGNATU ;G-' - -" 9103 DAVENPORT ST. N.E. BLAINE,MN 55449 (763) 786-8617 PHONE CERT. NO. 2 2 2 y (763) 786-8640 FAX