HomeMy WebLinkAbout2012-08-22 Backflow Preventor (RPZ) Test Report - Fountain Room 2012-08-23 13:54 INTERSTATE TESTING 7637555365» P3/13
Cross Connection Control Device Performance Test
interstate Testing
2140141st Ave. NW.
Andover Mn. 55304
Phone (783) 7444148
OWNER INFORMA • .
Csyter Name Street Address
4 ityil t Zip Code Owners &t act Telephone Number
J►„ Ar O r-T,,tei ( 6 >) 77c c �: • 9
FACILITY Y INFORMATION
Facility 4 •C . Pt • Sestet / es. , i <P S 7 .A.1.-.,
e. ., lip Code County
CiAk l�T /5 /,7s
Assattey ,y- 41'744(--°- yI F
/ " 1 k I s1 _ ite''+� I J 4 i r - t`'‘ , 1 . 1 7 4 r
Model Serial Number
w ► Lk / h { 97 Z— 30•• - 7 26Co
Size _ 3/v i Assembly Type O RP Detector 0 DC 0 DC Detector 0 PVB/SVB
INITIAL TEST ro tZP raliei valve
.1 _dinar Lycoes0 C ed tight Mated M a �h PSID
L❑ leaked - Leaked u Did not open
Static 7 , !-' PSID Static C PSID
MAL Closed s
El eer ❑ Closed tight Opened at PSID
Static PSID Static PSID
DETECTOR BYPASS A*$ IIILY INITIAL TEST reiMf Halve
❑ Ct tmM L7 Closed tgnt Opened at PSID
C Leaked ❑ Leaked D Did not open
Styift PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST ?SIG
❑ Closed dpt t 0 Closed tIght
Static PSID Static • PSID
PRESSURE VACUUM SOAKER INRUIL TEST I PREIURE VACUUM BREAKER FINAL ?EST
Si Snit vats � . - ' .
pperted at PSID � p M Opened et PSID tgM PSID Static • CJ Did ,we open
Static PSID
COMMENTS , -)-1-:
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCT E PERSONALLY.
Testa' Name (Print) n4,7 4 a)/ .Th r Repistration No. oc•s323 -97 Time of Day
Taster Signature C__Cct• Pr2tS----/g-1 Phone No. 7 (0/ 7 Vy 4. se y DOGS Fb 11L.