HomeMy WebLinkAbout2012-08-22 Backflow Preventor (RPZ) Test Report - Main Floor Garbage Area 2012-08-23 13:54 INTERSTATE TESTING 7637555365» P2/13
Cross Connection Control Device Performance Test
interstate Testing
2140 141ot Ave. NW.
Andover Mn. 56304
Phone (I 63) 744-6149
OWNER INFORMATION
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FACILITY INFORMATION 1
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Model Send Number
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PSID Static rs-- PSID
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Static PSIO Sc MID
%RECTOR BYPASS AMY INITIAL. TEST
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Static POD Sank PSID
DETECTOR BYPASS ASSEMSLY FINAL TEST
0 Closed tight 0 Closed datit Opened at PSID
Stade PSID Static PS1D
PRESSURE VACUUM BREAKER INITIAL. TEST PRESSURE VACUUM BREAKER FINAL TEST
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COMMENTS • •
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name (print) D 0+1 Pc i 1 1 te-fr Registration No. Otsc 313 R rTiree of Day
Tester Signature C9e" h-14. Phone No. -741 Date
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