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Home My WebLink About2023 Interstate Testing Report Aug.02.2023 12:03 PM Interstate Testing 7637555365 #9076 P 2/29 • Interstate Testing, P.O.BoeSS Backflow Assembly Test Report . Anoka,MN S5303 (RPZ,DCVA,PVB,SPVB,) (763)7446149: .. lnterstatetesdng@cotntast.riet = . . Property/Owner Information _ P uperty:Name' Boutwell Landis p Addrir . 5260 Nolan Parkway cityl: ' States "Zip Oak Park Heights 1/1. 5508 Q. .. 0. Ooftad/Phones#: Nadr ?doges • Mike Mader �. x(651)275 5012 irlmr r.rw rem.i..�...p,. :;Pcopeityownet Addrt ss`: Address:- : 5600 Norwich Parkwa Oak Park Hei•fits MN 55082 i ry "State:. Z#pe Oak Park Hei.hts . MN 55082 elii.ip '.o ttier loit0: * • :Phone .. Presbyterian Homes SBoutwell Landing) (651)275-5012 Type of Assembly/Workk Performed •Rte.: ' .• Iwo . . :. .TestX Aepair_88_ Fest Repast RD Test 11ep10Rit Backflow Assembly Information Site a kin Mioadl: ::Setiiilttr''.: ste SeOleed:. 3/4" W'Ikins . 975XL 1794356 Trash Chute Rinse Location ofAssetnbly: • • =u� •ing, .s room Backflow Assembi Test Results 'Type of cliecklfatve#x Shut Off.Valve 02 Relief Valve/ . Chuck 'sive Assenibl* A,tir ialetValve Rim ' Opm Mad — Open Cloned . Opened et ,Q paid , Open Clcsed.. PlessuiroDUs, 8.5. psid Did not open A. DCVA d Ciosed .Oped Closed Pressuha DUE paid Pressure Din. psid :.P . ? ... - p i pVg . Uosed Openedat,.,.r._;,,,,.psid Di}ne Closed Pressure DUE .paid. Did not open C+omrnents3 !Ass.; X; Tester's information tester`a,Namet. ; • Tester's S'tgnatare: Ceiitifications+P .Date: Donn Miller p :., BF065323 08-01-23