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HomeMy WebLinkAbout2004-03-08 Mid-City Mechanical Annual RPZ Test Report - Watts 71136 , --• ANNUAL TEST REPORT ''''' REDUC. iRESSURE ZONE BACKFLOW h ENTERS DOUBLE CHECK VALVE ASSEMBLIES 'ANUFACTURER U- / r:..( MODEL (7 01 T SIZE / SERIAL# .7 (I 3 NAME OF FACILITY (J 4 / 1/6 (t .t C COUNTY ADDRESS (STREET, CITY, ZIP) ( Z- 0 1, Le- V e f .y LOCATION OF DEVICE IN BUILDING °6 // Av,L O. — Oq/c grlc kf i re, CHECK VALVE NO. 1 CHECK VALVE NO. 2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT PSI TEST CLOSED TIGHT ( ) CLOSED TIGHT ( ) REDUCED PRESSURE DID NOT OPEN ( ) DESCRIBE CLEANED (V) 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 (vJ SEAT (,/) SEAT (✓) SPRING ( ) SPRING ( ) SPACER ( ) GUIDE ( ) GUIDE ( ) OTHER - -- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER -- ( ) OTHER -- ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: FINAL CLOSED TIGHT (/5 CLOSED TIGHT (V) OPENED AT3. 3 PSI TEST U REDUCED PRESSURE e INITIAL TEST BY DATE SIGNATURE REAIRED BYP e �a f,G " ! DATE 3 SIGNATURE --7 v %` ^ INAL TEST BY: MID-CITY MECHANICAL DATE 3 e -- ° '7 SIGNATURE1 7 '-- 9103 DAVENPORT ST. N.E. BLAINE, MN 55449 (763) 786 -8617 PHONE CERT. NO. 6 " c9. ) 2 V 7' (763) 786 -8640 FAX