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HomeMy WebLinkAbout1999-03-01 Mid-City Mechanical Annual RPZ Test Report - Watts 51202 ANNUAL TEST REPORT - REDUCED PRESSURE ZONE BACKFLOW PREVENTERS DOUBLE CHECK VALVE ASSEMBLIES l MANUFACTURER * MODEL 0 ©9 SIZE 1 WO 2 -- SERIAL# 57Z ' Z-- NAME OF FACILITY Valvoline Instant Oil Change COUNTY ADDRESS (Street, City, Zip) 5800 Neal Ave. , 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 - f ) - Opened At 3.-)PSI Test Closed Tight (y ) Closed Tight OS - ) Reduced Pressure I • 0 Did Not Open ( ) DESCRIBE Cleaned ( ) Cleaned ( ) Cleaned ( ) REPAIRS Replaced: ( ) Replaced: ( ) Replaced: ( ) Disc ( ) Disc ( ) Disc Assembly ( ) Disc Holder ( ) Disc Holder ( ) 0-Rings ( ) Stem ( ) Stem ( ) Stein ( ) 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 ( x') Closed Tight (') Opened At 3. SPSI Test • , • 0 Reduced Pressure INITIAL TEST BY • _,, , I ATE - I "9. SIGNATURE isziwirA Jr J REPAIRED BY DATE SIGNATURE FINAL TEST BY: Mid -City Mech. Corp. DATE 3 - / SIGNATURE 9107 Davenport St. NE Blaine, MN 55449 (612- 757 -7100) 0/6 0 / 1