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HomeMy WebLinkAbout2005-04-04 Mid-City Mechanical Annual RPZ Test Report - Watts 51202 • P"1 ANNUAL TEST REPORT '• REDUCED rRESSURE ZONE BACKFLOW PkE. VENTERS DOUBLE CHECK VALVE ASSEMBLIES NUFACTURER Watts MODEL 0 0 9 SIZE 1 / 2" SERIAL# 12 0 2 NAME OF FACILITY Valvoline Instant 0 1 Change COUNTY ADDRESS (STREET, CITY, ZIP) 580 Neal Ave N. -Oak Park Heights , MN LOCATION OF DEVICE IN BUILDING CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED ATP 7' PSI TEST CLOSED TIGHT (4 CLOSED TIGHT (4 REDUCED PRESSURE DID NOT OPEN ( ) -7o 6 DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC. ASSEMBLY ( ) DISC HOLDER ( ) DISC HOLDER ( ) • 0-RINGS ( ) STEM ( ) STEM ( ) STEM ( ) 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 /V iA e F,,,,, / _1 c, DATE ' / " ` 0 -S SIGNATURE - � /7 - - AIRED 1 DATE SIGNATURE FINAL TEST BY: MID -CITY MECHANICAL DATE Li - y s SIGNATURE - 7 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 786 -8617 PHONE CERT. NO. �_ `f (763) 786 -8640 FAX