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HomeMy WebLinkAbout2002-03-08 Mid City Mechanical RPZ Annual Test Report • '-N ANNUAL TEST REPORT REDUCL PRESSURE ZONE BACKFLOW I. .. VENTERS DOUBLE CHECK VALVE ASSEMBLIES �( Z Oda MANUFACTURER LvATT� MODEL �O g SIZE 3�y SERIAL# `� NAME OF FACILITY V/.ALUOLIA11 .2NS T 4A/T 6/L 6ifkodri COUNTY 4114SH/'t' T 'J ADDRESS (STREET, CITY, ZIP) Sq CS Qs6006 gv.2 6,r P4K HE/6-h7 f LOCATION OF DEVICE IN BUILDING Z-Dw Li LEvlL 13-r (,✓ALL CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT PSI TEST CLOSED TIGHT (X) CLOSED TIGHT ( r ) REDUCED PRESSURE DID NOT OPEN (K) 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: d ' th.S6940 6 isAs in&id 77AnG,6 4- GLkn,'ii - 77csr slice- mLE1 SPECIAL COMMENTS: ,ALS a r.asrAtila �il�4TT.S3i4'' sw'r 6Ac< vAeuE Ob/i[2 NAvlti w,T-H. �k 9d9 er a�chusE , xS,s?,N4 FA,LE0 FINAL CLOSED TIGHT (X) CLOSED TIGHT (k) OPENED AT 2,( PSI TEST REDUCED PRESSURE 9y 7. e- INITIAL TEST BY A 1 fM -MT ZJ( DATE 3- ''0 2 SIGNATURE �1� �"`6 :7, B PAIRED i----31A- A .a TZKE DATE 3` "0 Z- SIGNATURE ° ,/ FINAL TEST BY: MID-CITY MECHANICAL DATE SIGNATURE 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 757-7100 PHONE CERT. NO. C/Z 5-ZT (763) 786-8640 FAX