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HomeMy WebLinkAbout1998-04-03 Mid City Mechanical RPZ Annual Test Report ANNUAL TEST REPORT REDUCC`SRESSURE ZONE BACKFLOW P' iCVENTERS I,UUBLE CHECK VALVE ASSEMBLiLS ON400 3 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. 1 Check Valve No. 2 Relief Valve (For RPZ Only) Initial Leaked ( ) Leaked Test ( ) Opened At Z�Z PSI Closed Tight ( ) Closed Tight ( X) Reduced Pressure g,c0 Did Not Open ( ) DESCRIBE Cleaned ( ) Cleaned REPAIRS ( ) Cleaned ( ) Replaced: ( ) Replaced: ( ) Replaced: ( ) Disc ( ) Disc ( ) Disc Assembly ( ) Disc Holder ( ) Disc Holder ( ) O-Rings ( ) Stein ( ) 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: xtip Lif AL Final Closed Tight (NI``) Closed Tight (X ) Opened At Z.ZPSI Test C \(40 Reduced Pressure INITIAL TEST BY -\1 w4 10-1?1(' DATE LI-3 •- SIGNATURE 6`/,li,..0 "0/z REPAIRED BY DATE SIGNATURE FINAL TEST BY: Mid-City Mech. Corp. DATE SIGNATURE 9107 Davenport St. NE Blaine, MN 55449 (612-757-7100) a