HomeMy WebLinkAbout2022 Interstate Testing Report Aug.08.2022 10:09 AM Interstate Testing 7637555365 #2050 P 2/ 2
interstate Testing,LLCP.O.Box 55 Backflow Assembly Test Report
Anoka,MN SS303
F763j 7446149 (RP7,DCVA,PV$,SPVBx)
Intarstatetesdng@corncastnet. CitY%
Pro arty Owner Information
Property Name: 8outwell Landing
property Address. Addres
,5260 Nolan Parkway city: States Zip:'
r .
Oak Park Heights rk4K ;55082
Pro ertytontact/ptwnet Name; Phew,:
Mike Mader (651)275-5015
Pro Ownars Address.; address;
5500 Norwich Parkway Oak Park Heights MN 55082
CityState: Z p.
Oak Park Heishts MN 55082
PropertyIOwner/Phone:#: ' Names Phone:
Presbyterian Homes Boutwell Landin 51 275-5015
e of Assembi /Work Performed
Yin PV13 PIM.... DCVA
Test.,2L Repair R$ , ,Test Repair RB Test Repair RB .. Test -,Repair .RB
Backflow Assembly Information
Size: .Make: l Modelr' SerWalft_
3/4" Wilkins 975XL 1794356 Trash Chute Rinse
Location ofAssembly: = • c ui .ing, 'ras room
Backflow Assembly Test Results
'hype of Check Valve.01 Shut Off Valve 02 Relief Valve/ Check Valve 02 ..
Assembler • Air,Inlet Valve
Rpz Opon Closed_„. Open ;.C6osed. X Openedst ,4.0 paid Open Clased
Pressure DitT. pod Did not open
Dcwk Open Closed- -- Open Cloned Open..`.;_..., rafted
Pressure DIM paid Prwasare DUL paid
Olsen",_,; Closed Opened st__-___-.paid
'VMfSP!. . Open Qoeed
Pressure DIM' _paid Did not open
Comments:
PASS..:. FAIL; :,.
Tester's.information
Tester's Name: - • feteir's Signature: CerclRration N: Date:
Donn Miller BF065323 08-02-22