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HomeMy WebLinkAbout2005-05-27 Mid City Mechanical RPZ Annual Test Report * '`" ANNUAL TEST REPORT '"c REDUCED rRESSURE ZONE BACKFLOW Pk VENTERS DOUBLE CHECK VALVE ASSEMBLIES 2- ---..,NUFACTURER Watts MODEL�1)..9.. SIZE 3/4" SERIAL# NAME OF FACILITY Valvoline Instant Oil Change COUNTY Washington ADDRESS (STREET, CITY, ZIP) 5965 Osgood Ave, Oak Park Heights , MN LOCATION OF DEVICE IN BUILDING Lower Level , West Wall CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT�,iPSI TEST CLOSED TIGHT ( CLOSED TIGHT (u-) REDUCED PRESSURE Az L DID NOT OPEN ( ) /t/"2. moi: - DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC. ASSEMBLY ( ) '"1 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: w I r K t,1 S rvieY 4 9 -7.- X L s (-'L 9- j Lj 1e 10/et ( ‹e C(t''o FINAL CLOSED TIGHT ( ) CLOSED TIGHT ( ) OPENED AT PSI TEST REDUCED PRESSURE INITIAL TEST BY /1/1;/ t-' ( a 7,5'C- 4 DATE -'` '<<J� SIGNATURE1 - RAIRED I DATE SIGNATURE FINAL TEST BY: MID-CITY MECHANICAL DATE ..L.'-'-? 7"a Jr SIGNATURE -Of '74-.;.c:::-- - 9103 p- c. r-9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 786-8617 PHONE CERT. NO. 0 a Y (763) 786-8640 FAX