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HomeMy WebLinkAbout1999-03-01 Mid City Mechanical RPZ Annual Test Report ANNUAL TEST REPORT REDUCMPRESSURE ZONE BACKFLOW :EVENTERS iiOUBLE CHECK VALVE ASSEMBLIES MANUFACTURER Watts MODEL 909 SIZE 3/4" SERIAL# 24003 NAME OF FACILITY Valvoline Instant Oil Change COUNTY Washington ADDRESS (Street, City, Zip) 5965 Osgood Ave. , Oak Park Heights LOCATION OF DEVICE IN BUILDING Lower Level Check Valve No. I Check Valve No. 2 Relief Valve (For RPZ Only) Initial Leaked Test ( ) Leaked ( ) Opened At PSI Closed Tight (-) ) Closed Tight ( c,) Reduced Pressure 0 . I Did Not Open ( x) DESCRIBE Cleaned ( ) Cleaned REPAIRS ( ) Cleaned (�) Replaced: ( ) Replaced: ( ) Replaced: ( ) Disc ( ) Disc ( ) Disc Assembly ( ) Disc Bolder ( ) Disc Holder ( ) 0-Rings ( ) Stem ( ) Stein ( ) ( ) SfCtll Retainer ( ) Retainer ( ) Spring ( ) 0-Rings ( ) 0-Rings ( ) Diaphragm ( ) Seat ( ) Scat ( ) Seat ( ) Spring ( ) Spring ( ) Spacer ( ) Guide ( ) Guide ( ) Other--- ( ) Bushings .. g ( ) Bushings ( ) Describe Below: Other-- ( ) Other--- ( ) Describe Below: Describe Below: SPECIAL COMMENTS: ¶ r r ► 0,_,, tiOa' 41-; - --,./4., Final Closed Tight ( ) Closed Tight Test (-A ) Opened AtZ. MPSI se i4 Reduced Pressure INITIAL TEST BY.)er1...---1-1,A,_ DATE 3-- t-- `nSIGNATURE REPAIRED BY Jo epk. L c.d DATE -3-1 -4” SIGNATURE Wci d FINAL TEST BY: Mid-City Mech. Corp. DATE . 3-/-9? SIGNATURE I 9107 Davenport St. NE Blaine, MN 55449 (612-757-7100) C7f d;