HomeMy WebLinkAbout2006-05-24 RPZ Test Report 06/02/2006 09:26 6512289201 ST PAUL PLUMBING PAGE 03
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND /d_r�
TESTABLE DOUBLE CHECKS �`
SAINT PAUL REGIONAL WATER SERVICES
.,
Service Name: ,— Contact Person /Tele -
Address; 5Q P:' 0 x _bo tb 0i'v-c_ C it y : Od k P 4 VI - State: » Zip: __•
Device Location: Mi Aea- _ ro"- - out Sig I- Serve what system; Ser�k k I !*s _ s u s I
Account Number: _ Serial Number. 788, 9os`
Type: Make: L I l C r S Model: 975k(`Size: � is
t)
Install Date: ? Air Gap Installation Date — _-„_.
Rebuild Date: �� Test Date: 5 — a `i — ?-0 O !c
Annual Check Valve #1 Check Valve #2 Differential Pressure Relief Valve
Report
Pressure air4 • e7 Pressure 77 k•f" Opened at 4 /• I psid reduced pressure.
Did not open
Cleaned Cleaned Cleaned -
• Replaced _ Replaced . Replaced
R Oisc Disc Disc. Upper
E Spring ______ Spring Disc, Lower
P • Guide _ Guide • Spring
A Pin.Petainer Pin Retainer Diaphragm, Large
1 Hinge Pin Hinge Pin Lower
R _ Seat — Seat Upper
S Diaphragm .
iaphragm Diaphragm _ Diaphragm. Small
Other, describe Other, describe Lower
- - r Upper
. . Seat:
Lower
Upper
• - -- ----- Spacer, Lower
Other, describe
f /I Sign and date Tag
The above is certified correct. Signed _ — DateTesled:
Tested by ,(Print Name) Certification Number
Company Name: License Number __
1
Company Telephone Number —
All sections of this reporl rnusl be completed. Number olaevIces Fee per Device
Return to: Saint Paul Regional Watc;r Services First $ 30
8 4th St E Ste 400 Devices 2 -21 $ 25
Saint Paul, MN 55101- 1007 22 and over $ 15
Return with fee: payable. to the hoard of Water Commissionrrc