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HomeMy WebLinkAbout2004-05-21 Mid City Mechanical RPZ Annual Test Report ANNUAL TEST REPORT �~ REDUC. PRESSURE ZONE BACKFLOW Phr.VENTERS DOUBLE CHECK VALVE ASSEMBLIES 00--22� SERIAL# NUFACTURER Watts MODEL 909 SIZE 3/4" -2-449-3- 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, _e S.V �,,.Q,L, CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT PSI TEST CLOSED TIGHT ( (4" CLOSED TIGHT ( ) REDUCED PRESSURE DID NOT OPEN ( 0'--- DESCRIBE DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED (,—j 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 ( r� SEAT ( ) SEAT ( ) SEAT SPRING ( ) SPRING ( ) SPACER (( ) GUIDE ( ) GUIDE ( ) OTHER--- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER-- ( ) OTHER-- ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: &-/ 1�4' i v e.4.,c ,,T zs/ne, e b,,; / t r.e l v e r 1' t c�-1` FINAL CLOSED TIGHT (i ) CLOSED TIGHT ( 4' OPENED AT3, . PSI TEST '..._s--- REDUCED PRESSURE INITIAL TEST BY f 11 ,1 -e 1?' Tt (-1,1 DATE .5---.31/4, /`�'(7 SIGNATURE7 ,& '--72------- i�IRED �--� B` /�,/ rgz_f "4J L DATE ' Z /'G y SIGNATURE CI `�- > ,C2— - FINAL TEST BY: MID-CITY MECHANICAL DATE 5 I'G 474 SIGNATURE- 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 757-7100 PHONE CERT. NO. 2 3 ) (:.( 7 (763) 786-8640 FAX