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HomeMy WebLinkAbout2006-04-27 Mid-City Mechanical Annual RPZ Test Report - Watts 51202 , ,.--N ANNUAL TEST REPORT �.� REDUCE RESSURE ZONE BACKFLOW Pi /ENTERS DOUBLE CHECK VALVE ASSEMBLIES "-MANUFACTURER Watts MODEL 009 SIZE %2" SERIAL# 51202 NAME OF FACILITY Valvoline Instant Oil COUNTY ADDRESS (STREET, CITY, ZIP) 5800 Neal Ave. N., Oak Park Heights, MN Store #96 LOCATION OF DEVICE IN BUILDING CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( LEAKED ( OPENED AT f ) PSI TEST CLOSED TIGHT ( CLOSED TIGHT ( ) REDUCED PRESSURE C DID NOT OPEN ( ) DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC. ASSEMBLY ( ) DISC HOLDER ( ) DISC HOLDER ( ) 0-RINGS ( ) STEM ( ) STEM ( ) STEM ( ) n RETAINER ( ) RETAINER ( ) SPRING 0-RINGS ( ) 0-RINGS ( ) DIAPHRAGM ( ) SEAT ( ) SEAT ( ) SEAT ( ) SPRING ( ) SPRING ( ) SPACER ( ) GUIDE ( ) GUIDE ( ) OTHER - -- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER -- ( ) OTHER -- ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: FINAL CLOSED TIGHT ( ) CLOSED TIGHT ( ) OPENED AT PSI TEST REDUCED PRESSURE INITIAL TEST BY / ( i r a �,t C--'n DATE - ) L SIGNATURE ----/ . ( - - REPAIRED BY DATE SIGNATURE NAL TEST BY: MID -CITY MECHANICAL DATE 4 ' 3 7 SIGNATURE - 0 ` - 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 786 -8617 PHONE CERT. NO. <% ? ?,, t{ r (763) 786 -8640 FAX