HomeMy WebLinkAbout2011-07-27 J-Berd Annual Backflow Preventers Test Reports J -Berd Mechanical Contractors, Inc. LETTER OF TRANSMITTAL
Date Job No.
3308 Southway Drive 27- Jul -11 10 -1333
Attention
St. Cloud, MN 56301
RE
320 - 656 -0847 Oakgreen Commons
320 - 656 -0312 Oak Park Heights, MN
J Ut_
TO: City of Oak Park Heights /3 93 4, s* 514
ATTENTION:
WE ARE SENDING YOU ❑x Attached ❑ Under separate cover via the following items:
❑ Shop Drawings ❑ Prints ❑ Plans E Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
Copies Date Serial No. Description
1 7/26/2011 Annual Test - Backflow Preventer for area (s) :
2402747 Trash Room
3438553 Mechanical Room
L61659 Mechanical Room
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
For your use ❑ Approved as noted ❑ Submit copies for distribution
As requested ❑ Retumed for corrections ❑ Retum corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 20 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS Please retain this documentation for your files.
Thank you!
COPYTO File
SIGNED Sondra Peterson
,... v _....': _ n., y.. tea:.:. 7 . ...a :^�.� -t'�" �. °' t .'+ri:: •-¢ r a: >a .. v > +w a
• 1b -133
�.. u,\ \ i ANNUAL TEST -
c� ERD �..
��� Mechanical Contractors, Inc. r K'L+QW PREVENTERS
v
Customer r ., , '
Street Address 1 i 1i , f f .
Mailing Address --�'`
Property Owner 1 2 ( 1 . 1 > \, t 1 L_L_C'
Street Address () Ct
Mailing Address , 1(1 VV. i (,' k KAN 1 'j ) 2---
Location of Assembly 1 7 , .. . -7,-..-%
Type of Assembly: RPZ ❑ DCV ❑ PVB ❑ Size `- ., /-- /
Manufacturer: L4 j i Ki, i Model: ! 1S XG.-. Serial #: 2 M Li 4: 1 `-
CHECK VALVE #2 CHECK VALVE #2 PRESSURE
CHECK VALVE #1 RELIEF VALVE TEST #1 TEST #2 VACUUM
• BACK PRESSURE CONFIRMATION BREAKER
❑ leaked -� ❑ leaked ❑ leaked air inlet opened at pel
El closed tight opened at: it. r s psi ❑ closed tight El closed tight did not open ❑
Differential pressure Differential pressure Differential pressure Check valve:
across check valve did not open ❑ across check valve across check valve
. psi V , a psi 1, ,;r psi leaked ED
held at psi
❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only
Replaced: Replaced: Replaced: Replaced: Replaced:
rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑
CV assembly ❑ RV assembly ❑ CV assembly ❑ CV assembly ❑ CV assembly ❑
or disc ❑ or disc ❑ or disc ❑ or disc ❑ disc, air in ❑
o -rings ❑ diaphragm(s) ❑ o -rings El o -rings ❑ disc, CV ❑
seat ❑ seat ❑ seat ❑ seat ❑ spring, air El
spring ❑ spring ❑ spring ❑ spring ❑ spring, CV ❑
stem/guide ❑ guide ❑ stem/guide ❑ stem/guide ❑ retainer ❑
retainer ❑ o -rings ❑ retainer ❑ retainer ❑ guide ❑
lock nuts ❑ other ❑ lock nuts ❑ lock nuts ❑ o -ring ❑
other ❑ other ❑ other ❑ other ❑
Differential pressure Opened at Differential pressure Differential pressure Air inlet psi
across check valve across check valve across check valve
psi p psi •psi Check valve psi
NOTE: ALL REPAIRS SHALL BE COMPLETED WITHIN TEN (10) DAYS.
REMARKS: /.'1 ( 3Y 1/ 'it" 1 t ( t; 7/ - /.0.1-4-
1 HEREBY CERTIFY THAT THIS DATE IS ACCURATE AND REFLECTS THE PROPER OPERATION AND MAINTENANCE OF THE
ASSEMBLY. -,
TESTER'S NAME (PRINT) S:i, -- 310,-k /' / .1.., .i`' CERT. # L c -G~ -77/ - 'f
TESTER'S SIGNATURE ° °` DATE f Jr,;!
1
- ERD 'F ANNUAL TEST —
J ` Mechanical Contractors, Inc. `EACKFLOW PREVENTERS
`. EUl 9 rl r: n o 1
Customer . , , Y.1 : 1 ,.
Street Address -- ' — 4 , ,,,J ('
ddress c
(-
Mailing Address
Property Owner CA'( = 1 fi `N!{ c) L._
Street Address U )U K � t !
^ \ f
Mailing Address ' . 1 1 U `� -t l _ V" , iN `'+ L 2---
Location of Assembly (Y\ , _ti, . i �.:, 4
Type of Assembly: RPZ 0 DCV ❑ PVB ❑ Size l '/:-.)-
Mwwfacturer: 1A) i k /,,.t Model: 7- 73 Serial #: 7-3 :;17'35
CHECK VALVE #2 CHECK VALVE #2 PRESSURE
CHECK VALVE #1 RELIEF VALVE TEST #1 TEST #2 VACUUM
BACK PRESSURE CONFIRMATION BREAKER
❑ leaked ❑ leaked ❑ leaked air inlet opened at psi
❑ closed tight opened at: 'psi 0. closed tight ®'closed tight did not open ❑
Differential pressure Differential pressure Differential pressure Check valve:
acrom check valve did not open ❑ across check valve across check valve leaked El si�si held at psi
❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only
Replaced: Replaced: Replaced: Replaced: Replaced:
rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑
CV assembly ❑ RV assembly ❑ CV assembly ❑ CV assembly ❑ CV assembly ❑
or disc ❑ or disc ❑ or disc El or disc ❑ disc, air in ❑
o -rings ❑ diaphragm(s) ❑ o -rings ❑ o -rings ❑ disc, CV ❑
seat ❑ seat ❑ seat ❑ seat ❑ spring, air El
spring ❑ spring ❑ spring ❑ spring ❑ spring, CV ❑
stem/guide ❑ guide ❑ stem/guide ❑ stem/guide ❑ retainer El
retainer ❑ o -rings ❑ retainer ❑ retainer ❑ guide ❑
lock nuts ❑ other ❑ lock nuts ❑ lock nuts ❑ o -ring ❑
other ❑ other ❑ other ❑ other ❑
Differential pressure Opened at Differential pressure Differential pressure Air inlet psi
across check valve across check valve across check valve
psi p psi .psi Check valve psi
NOTE: ALL REPAIRS SHALL BE COMPLETED WITHIN TEN (10) DAYS.
REMARKS: ) . - c t z ;l ) t "f` I c 3 : 7/ ( e 1 c - e
1 HEREBY CERTIFY THAT THIS DATE IS ACCURATE AND REFLECTS THE PROPER OPERATION AND MAINTENANCE OF THE
ASSEMBLY. -- _
TESTER'S NAME (PRINT) ,`� -4v'► , - f'1 -/ f1 ` /t CERT. # GYt(- 7 J-,i'
TESTERS SIGNATURE '- ` DATE r
... _ ... _ :_ ..v' -n'F- , 1!r�t:.E P'a i..:.4�. LT "'•.:;ssa^r . y�tt�'1l -€.: " ""L ,;^t's _.3r..c.. r.'q+ - "" , "r, '.t+^ :<nrh*' fWS - .,.
0 . `, ' y IC).- l '33
l ar E R D _m u�y.,.. # ANNUAL TEST —
L4 Mechanical Contractors, Inca A CKFLOW PREVENTERS
v JU L 2 r ,
Customer . . e: ; y_ 1
Street Address ( ti. R . .. _Ai , . - , , , , :-..
Mailing Address {{
Property Owner
bitt r\ SN ! 1 IS i
Street Address k, 0 i , ( i 1 ! ,
Mailing Address . ' l# 1 V t r - U f (,'V i 1 N � "J V 2
Location of Assembly / "`C c.:r\ q' core).
Type of Assembly: RPZ Q DCV ❑ PVB ❑ Size `,
Manufacturer. I n A., i,1 i Model: 3 / 3 Serial #: L.» co) t` a, -
CHECK VALVE #2 CHECK VALVE #2 PRESSURE
CHECK VALVE #1 RELIEF VALVE TEST #1 TEST #2 VACUUM
BACK PRESSURE CONFIRMATION BREAKER
❑ leaked ❑ leaked ❑ leaked air inlet opened at psi
Crclosed tight opened at: .' psi ,® closed tight Cli closed tight did not open ❑
Differential pressure Differential pressure Differential pressure Check valve:
acrom check valve did not open ❑ ac ctr valve acroal check valve
�:° leaked ❑
psi . v psi - nsi held at psi
❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only ❑ Cleaned only
Replaced: Replaced: Replaced: Replaced: Replaced:
rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑ rubber kit ❑
CV assembly ❑ RV assembly ❑ CV assembly El CV assembly ❑ CV assembly ❑
or disc ❑ or disc ❑ or disc ❑ or disc ❑ disc, air in , ❑
o -rings ❑ diaphragm(s) ❑ o -rings ❑ o -rings ❑ disc, CV ❑
seat ❑ seat ❑ seat ❑ seat ❑ spring, air ❑
spring ❑ spring ❑ spring ❑ spring ❑ spring, CV ❑
stem/guide ❑ guide ❑ stem/guide ❑ stem/guide ❑ retainer ❑
retainer ❑ o -rings ❑ retainer ❑ retainer ❑ guide ❑
lock nuts ❑ other ❑ lock nuts ❑ lock nuts ❑ o -ring ❑
other ❑ other ❑ other ❑ other ❑
Differential pressure Opened at Differential pressure Differential pressure Air inlet psi
across check valve across check valve across check valve
psi p _ _psi .psi Check valve psi
NOTE: ALL REPAIRS SHALL BE COMPLETED WITHIN TEN (10) DAYS.
REMARKS: 1 /1 { j 11 . c r> k J/ 2 I /
1 HEREBY CERTIFY THAT THIS DATE IS ACCURATE AND REFLECTS THE PROPER OPERATION AND MAINTENANCE OF THE
ASSEMBLY.
TESTER'S NAME (PRINT) - T -i - / ,t . if CERT. # (,, ( Cr X7 c /---
TESTER'S SIGNATURE . ` _ /
-- -- - ._ DATE 7k) (. i -4 d