HomeMy WebLinkAbout2012-03-26 Mid-City Mechanical Annual RPZ Test Report - Watts 71136 tit WS ANNUAL TEST REPORT
N EL) REDUCED PRESSURE ZONE BACKFLOW PREVENTERS
pi 46u DOUBLE CHECK VALVE ASSEMBLIES
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MANUFACTURER Watts MODEL 009M2QT SIZE 1" SERIAL# 71136
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 Lower Level
SERVICES WHAT SYSTEM Main line right after the meter, irrigation is separate
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 ( ) 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:
N per+ n o- exh.ov.)3 P- O CL)
SPECIAL COMMENTS:
FINAL CLOSED TIGHT (,() CLOSED TIGHT (,X) OPENED AT Z‘PSI
TEST 1.Z REDUCED PRESSURE
INITIAL TEST BY DATE SIGNATURE
REPAIRED
BY DATE SIGNATURE
BY: MID -CITY MECHANICAL DATE ?cot 'Z SIGNATURE !.� t.
FINAL TEST BY ?
. )1-6/L....-
9103 DAVENPORT ST. N.E.
BLAINE, MN 55449 (763) 786 -8617 PHONE CERT. NO. OtoOts1 F
(763) 786 -8640 FAX
MiD -CITY MECHANICAL CORP.
9103 Davenport Street N.E. * Blaine, MN 55449 (763) 786 -8617 PHONE
(763) 786 -8640 FAX
LETTER OF TRANSMITTAL
Date: 3/27/12
To: City of Oak Park Heights
14168 Oak Park Blvd
PO Box 2007
Oak Park Heights, MN 55082 -2007
Attn: Julie Hultman
From: Angie Reitz
RE: Valvoline Instant Oil Change #96
5800 Neal Ave N
Oak Park Heights, MN
We are sending via: ® Mail
QTY DESCRIPTION
1 RPZ Test Report.
Remarks: For your use. Thank you!
Signed: Angie Reitz