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HomeMy WebLinkAbout2003-04-04 Mid City Mechanical RPZ Annual Test Report '� ANNUAL TEST REPORT REDUCE... i'RESSURE ZONE BACKFLOW I__,!:VENTERS DOUBLE CHECK VALVE ASSEMBLIES 'e) OOc-77 MANUFACTURER Watts MODEL 909 SIZE 3/4" SERIAL# 244°-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 ,, p c-\s- ,,,:JCJ? � CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) 1,EAKED ( ) OPENED AT Y6 PSI TEST CLOSED TIGHT ( 0/CLOSED TIGHT ( -.. REDUCED PRESSURE I DID NOT OPEN ( ) 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 q,o'PSI TEST "ei REDUCED PRESSURE INITIAL TEST BY w"%C i( rd4,7 ; DATE q,-- '{ 0.> SIGNATURE/44-- REPAIRED IGNATURE 'rREPAIRED BY DATE SIGNATURE FINAL TEST BY: MID-CITY MECHANICAL DATE (/'V-03 SIGNATU • 1.-- 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 757-7100 PHONE CERT. NO. ( / F r- (763) 786-8640 FAX