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HomeMy WebLinkAbout2022-09-30 Ahern Fire Backflow Preventer Assembly Inspection Results ili........... 13705 26'^Avenue, Suite 110 Sprinkler Inspection Minneapolis, MN 55441 ® main 763.268.0515 I fax 763.268.0516 Annual I HERN. www . ahernfire . com Work Order: 1569867 Agreement: 54626 Inspection Start Date: 09/29/2022 Customer PO: Inspection Location _ Contact: Jay Farrell WalMart Store #18691 Cell#: (636) 828-3762 5815 Norell Ave N Phone#: (763)268.0515 Oak Park Heights MN 55082 E-Mail: jay.farrell@aiefirestl.com Gust ID: 101109 Loc ID: 206 Deficiency Recap: No Deficiencies Found Technician Comments: No Technician Comments NOTES: Any comments or findings in this inspection report are not in any way to be considered a fire protection engineering review. All fire protection system inspection and testing,as contracted with Customer is performed to the following NFPA codes and editions (listed as code-edition);10—2013,11-2005,12-2008,12A-2004,16-2007,17-2013,17A—2013,25-2011,72-2010,96 —2014,409-2011,750-2006,1962—2013,2001—2008 and Life Safety 101(Chapter 7)-2012. Any backflow preventers tested as part of this inspection were tested in accordance with all applicable state rules and regulations and all readings are true and accurate to the best of my knowledge. Michael S Sutherland Page 1 of 2 Inspection Contractor: J.F.Ahern/Ahern Fire Protection 13705 26th Ave Minneapolis,MN 55441-3635 Building Owner or Authorized Representative: Technician: Signature: Signature: / Name: Michael S Sutherland Name: Jay Farrell License#: BT766192 Customer Signature 09/30/2022 Inspection 09/30/2022 Date: End Date: This inspection report is expressly subject to the terms and bnditioht oY sale located at JF Ahern Terms and Conditions which are incorporated by reference as if fully set forth herein.By accepting this inspection report you are deemed to have read,understood and accepted the electronic terms and conditions of sale. Ahern will be contacting you shortly to discuss how we may help you create an action plan to correct deficiencies identified in this inspection. Copyright©2021 J.F.Ahern Co./Ahem Fire Protection,a division of J.F.Ahern Co.. • Michael S Sutherland Page 2 of 2 13705 26'° Avenue, Suite 110 Minneapolis. MN 55441 Backflow Preventer Assembly 6 main 763.268.0515 I fax 763.268.0516III Inspection Results HERNSE. www. ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Noxell Ave N Oak Park Heights,ALN 55082 Device Type: . 0 DC ❑ RPP 0 PVB/SVB Size: 8" Manufacturer: Ames Model: 2000SS Serial#: 137787 0205 Location at Property: Riser Room Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INI'ITAL 1'EST Held at 1_4 PSID Held at 15 PSID Opened at PSID Air Inlet: Closed Tight Yes 0 No 0 Closed Tight Yes 0 No 0 Did not open Opened at PSID Leaked Yes 0 No 0 Leaked Yes 0 No 0 Cleaned - , Did not open Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at PSID #2 Shut Off Yes 0 No ❑ Leaked Yes No Closed Tight Cleaned Replaced FINAL LEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST — First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at_PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# 7s J09/30/2022 / irry/ State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 1 of 11 13705 26th Avenue, Suite 110 iM Minneapolis, MN 55441 Backflow Preventer Assembly ® main 763.268.0515 I fax 763.268.0516 Inspection Results III HERNS,Nci,� www. ahernfire .com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Noxell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Wilkens Model: 720A Serial#: 13237 Location at Property: Produce Culligan Unit Repair Notes if Applicable NA I Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL 1'EST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at 3_0 PSID Leaked Yes No Leaked Yes No .t., Cleaned Did not open 0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 4.2 PSID #2 Shut Off Yes No Leaked Yes 0 No 0 Closed Tight Cleaned Replaced FINAL PEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet 3.0 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed'fight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# / 09/30/2022 Iii iiioip State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 2 of 11 13705 26th Avenue, Suite 110 j Minneapolis, MN 55441 Backflow Preventer Assembly ® main 763.268.0515 I fax 763.268.0516 I HERN.E��� www . ahernfire . com Inspection Results Owner/Contact Name: Jay Farrell Phone#: (763) 268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC El RPP 0 PVB/SVB Size: 3" Manufacturer: Watts Model: 909 Serial#: 179856 Location at Property: Riser Room Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL PEST Held at 60 PSID Held at 2.0 PSID Opened at 2_5 PSID Air Inlet: Closed Tight Yes El No 0 Closed Tight Yes 0 No 0 Did not open 0 Opened at PSID Leaked Yes 0 No 10 Leaked Yes 0 No 0 Cleaned .• :: , Did not open Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at PSID #2 Shut Off Yes El No ❑ Leaked Yes No Closed Tight Cleaned Replaced FINAL ZEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked' 0 Leaked 0 Did not Open Serial: Static PSID Static........ PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# t i ill09/30/2022 . Ai lif, . State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 3 of 11 13705 26th Avenue, Suite 110 Minneapolis, MN 55441 Backflow Preventer Assembly ® main 763.268.0515 I fax 763.268.0516 Inspection Results NI HERNs,NcEo www . ahernfire . com Owner/Contact Name: Jay FarrellPhone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP CZI PVB/SVB Size: 3/4" Manufacturer: Watts Model: 800M4QT Serial#: 405492 Location at Property: Front Mop Sink Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve P\B/ SVB INITIAL PEST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at 1_7 PSID Leaked Yes No Leaked Yes No Cleaned Did not open 0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 2.8 PSID #2 Shut Off • Yes No Leaked Yes ❑No 0 Closed Tight Cleaned Replaced FINAL 1'LST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID _ Air Inlet 1.7 PSID — DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static _. ..PSID......_..._......._............................._.........................................._Static.................... PSID Opened at PSID.............................................Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# t / �, 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 4 of 11 13705 26'' Avenue, Suite 110 Minneapolis. MN 55441 Backflow Preventer Assembly ® main 763.268.0515 ( fax 763.268.0516 Inspection Results II HERNWCE www . ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Ames Model: 2000B Serial#: 41196 Location at Property: Riser Room Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL TEST Held at 1.- PSID Held at 20 PSID Opened at PSID Air Inlet: Closed Tight Yes 0 No 0 Closed Tight Yes 0 No 0 Did not open Opened at PSID Leaked Yes 0 No 0 Leaked Yes 0 No 0 Cleaned Did not open Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at PSID #2 Shut Off Yes 0 No❑ Leaked Yes No Closed Tight Cleaned Replaced FINAL PEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed light 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked ❑Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# /tillZW/ \4�J r / 09/30/2022 �1 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 5 of 11 13705 26th Avenue, Suite 110 Minneapolis. MN 55441 Backflow Preventer Assembly main 763.268.0515 l fax 763.268.0516 Inspection Results HERNsI„E,BAo www. ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Watts Model: 800M4QT Serial#: 403973 Location at Property: Rear Mop Sink Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL FEST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at L88 PSID Leaked Yes No Leaked Yes No Cleaned Did not open 0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 2.4 PSID #2 Shut Off Yes No Leaked Yes 0 No El Closed Tight Cleaned Replaced FIN:k 1' ST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet 1.8 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# t p � dyI. 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 6 of 11 13705 26'Avenue, Suite 110 Minneapolis. MN 55441 Backflow Preventer Assembly i ® main 763.268.0515 1 fax 763.268.0516III Inspection Results HERNE. www . ahernfire . com Owner/Contact Name: Jay Farrell Phone #: (763) 268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Watts Model: 800M4QT Serial#: 044348 Location at Property: Bakery Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL PEST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at 2.4 PSID Leaked Yes No Leaked Yes_ No _ _Cleaned Did not open 0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 3.0 PSID #2 Shut Off Yes No Leaked Yes ❑No 10 Closed Tight Cleaned Replaced FINAL PEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID _Air Inlet 2.4 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 beaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# l sy l„ 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 7 of 11 13705 26th Avenue, Suite 110 Minneapolis. MN 55441 Backflow Preventer Assembly v main 763.268.0515 1 fax 763.268.0516 Inspection Results I HERN SINCE 1880 www . ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Noxell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC El RPP 0 PVB/SVB Size: 2" Manufacturer: Wilkens Model: 975XL Serial#: 037127 Location at Property: Garden Center Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SSB INITIAL 11.ST Held at 8.0 PSID Held at 2_6 PSID Opened at 4_0 PSID Air Inlet: Closed Tight Yes 0 No 0 Closed Tight Yes El No 0 Did not open 0 Opened at PSID Leaked Yes 0 No El Leaked Yes❑ No Q Cleaned Did not open Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at PSID #2 Shut Off Yes El No 0 Leaked Yes No Closed Tight Cleaned Replaced FINAL FEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed'Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at.......... _PSID._............__..-_...................Sue: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed'light 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# oil 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 8 of 11 e a 13705 26'° Avenue, Suite 110 Minneapolis, MN 55441 Backflow Preventer Assembly ® main 763.268.0515 I fax 763.268.0516 Inspection Results HERIV.. www . ahernfire . corn Owner/Contact Name: Jay Farrell Phone #: (763) 268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,YIN 55082 Device Type: 0 DC 0 RPP El PVB/SVB Size: 3/4" Manufacturer: Watts Model: 800M4QT Serial#: 044320 Location at Property: Deli Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB/ SVB INITL-1L PEST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at L88 PSID _ Leaked _ Yes No Leaked Yes No Cleaned. _ Did not open 0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 3.2 PSID #2 Shut Off Yes No Leaked Yes❑No El Closed Tight Cleaned Replaced FINAL TEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet 1.8 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed'light 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone # Certification# 1 .7, i, 9 40 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 9 of 11 13705 26th Avenue, Suite 110 Minneapolis, MN 55441 Backflow Preventer Assembly main 763.268.0515 I fax 763.268.0516 Inspection Results HERNE www. ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO #: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Watts Model: 800M4QT Serial#: 044435 Location at Property: Produce Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL l'EST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at 3.2 PSID Leaked Yes No Leaked Yes No Cleaned Did not open ❑ Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 3.4 PSID #2 Shut Off Yes No Leaked Yes❑No Closed Tight Cleaned Replaced FINAL PEST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet 3.2 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed"Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763)268-0515 State certified technician(please print) Company Name Phone# Certification# 4it- 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 10 of 11 13705 26th Avenue,Suite 110 Minneapolis, MN 55441 Backflow Preventer Assembly ® main 763.268.0515 ( fax 763.268.0516 Inspection Results III HERNSINCE MO www. ahernfire . com Owner/Contact Name: Jay Farrell Phone#: (763)268.0515 Business Name: AIE Inspection Services WO#: 1569867 Service Address: 5815 Norell Ave N Oak Park Heights,MN 55082 Device Type: 0 DC 0 RPP 0 PVB/SVB Size: 3/4" Manufacturer: Wilkens Model: 720-A Serial#: 13255 Location at Property: Meat Dept Repair Notes if Applicable NA Check Valve#1 Check Valve#2 Pressure Relief Valve PVB / SVB INITIAL PEST Held at PSID Held at PSID Opened at PSID Air Inlet: Closed Tight Yes No Closed Tight Yes No Did not open Opened at 2_0 PSID Leaked__ - Yes NQ_______ Leaked Yes No _ Cleaned Did not open___0 Cleaned Cleaned Replaced Check Valve: Replaced Replaced Held at 2.4 PSID #2 Shut Off Yes No Leaked Yes❑ No 10 Closed Tight Cleaned Replaced FINAL I'hST Closed Tight Yes No Closed Tight Yes No Check Valve PSID PSID PSID Opened at PSID Air Inlet 2.0 PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST First Check Second Check Relief Valve Make: ❑Closed Tight 0 Closed Tight 0 Opened Model: ❑Leaked 0 Leaked 0 Did not Open Serial: Static PSID Static PSID Opened at PSID Size: DETECTOR BYPASS ASSEMBLY FINAL TEST ❑Closed Tight 0 Closed Tight 0 Opened ❑Leaked 0 Leaked 0 Did not Open Static PSID Static PSID Opened at PSID I hereby certify that the above backflow preventer has been tested in accordance with all rules and regulations and that all readings are true and accurate to the best of my knowledge. Michael S Sutherland AFP Twin Cities Service (763) 268-0515 State certified technician(please print) Company Name Phone# Certification# 7 t / , . Etti ,- 09/30/2022 State certified technician(signature) Customer(signature) Date Inspection Date:09/29/2022 Page 11 of 11