HomeMy WebLinkAbout202-10-09 Backflow Preventor (RPZ) Test Reports - NAC Mechanical BACKFLOW PREVENTER TEST REPORT
JOB ADDRESS(INCLUDE ADDRESS#,STREET NAME,&DIRECTIONAL),Apt/Unit#
. C ) Ocn k - e_ /-42� 3L //i L
BACKFLOW ASSEMBLY INFORMATION(All Fields are Required)
System Served: L Manufacturer of Assembly: > 7 Model# �C a ,S
Size of Assembly: 3/4/ # J t�
Serial '
Location of Assembly: Floor# Pl�C.�t� ,.:�, I •r Room# Date test was performed: IL —Li'.
'.
Reduced Pressure Principle Backflow Preventer(RP)—TEST RESULTS
Check Valve#2 Shutoff Valve#2 j Check Valve#1 Pressure Differential
li Relief Valve
Closed Tight Li YesI \o CC°sea Tight GE Yes IINo Closed Tight Yes�Vo
Initial Test Pressure Drop Across Opened at 2, C.o psid
Check Valve#1 /0 psid
Describe parts and
repairs when needed
Closed Tight _Yes_No Closed Tight _Yes NO i Closed Tight Yes No
Final Test — Pressure Drop Across Opened at psid
Check Valve#1 psid
Double Check Backfiow Prevention Assembly(DC)—TEST RESULTS
Check Valve#1 Check Valve#2 Shutoff Valve#2
Closed Tight' fires=No Closed Tight�_Yes q o
initial Test Closed Tight Yes JNo
psid psid
Describe parts and
repairs when needed
Closed Tight=(es Llo Closed Tight Yesvo Closed Tight=Yes=No
Final Test
psid psid
Pressure Vacuum Breaker Assembly(PVB)or Spill Resistant Vacuum Breaker(SRVB)—TEST RESULTS
Air Inlet Valve ! Check Valve Shutoff#2
Failed to OperlYeED No Closed Tight ® Yes do
Initial Test
Pressure Drop Across Closed Tight —Ye No
Opened at psid Check Valve#1 psid
Describe parts and
repairs when needed
} Closed Tight I kes Civo 1 i (—
psid Pressure DropAcross Closed Tight L_ Ye1`No
Final Test Opened at
Check Valve#1 psid
CERTIFICATION:I certify the foregoing information provided by me to be correct and that the d device is functioning with the limits of the standards.
Name(Print): Signature: Date: /t"✓ Z'L)
,F
State of MN Certificate Number.
r✓ 9-c,Ov