HomeMy WebLinkAbout2012-08-22 Backflow Preventor (RPZ) Test Report - LL Soiled Laundry Room 2012-08 -23 13:54 INTERSTATE TESTING 7637555365» P 4/13
Cross Connection Control Device Performance Test
- . interstate Testing
2140141St Ave. NW.
Andover Mn. 66304
Phone (763) 744 -6149
OWNER INFORMAT)
Orr Name StreSt AO3noss
City - - Zip Code Oweers Contact Person Telephone Number
FACILITY INFORMATION _
..._ . ` Street Addnasa _ 7 � 7o code Ccunb
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tA L.- tevtt bItINc-i / I tetu WV Li 4t1 3 2 g 7 t_____,..
Number
Size -I it/ ,' Assembly Type ❑ RP,. aRill40041.00 ❑ DC ❑ DC Detector a PVB1SV
%a IAL TEST ti
li tight ��ht o �+ 3 V PSID
In Leaked not open
Static im PSID Static r _. PSID
St
MAL leer
Ctzeea ova ❑ caeea right Opened at PSID
Static PSID Static PSID
DE TECTOR BYPASS ASSEMBLY Y INR1AL TEST RP tageL�
IJ r tight U � d tight O at PSID
O Leaked O Did not open
Q Leaked
Ste dc PSID Startle PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST PSID
tight ❑ Closed tip PSID Opened at SIG
Static PSID Static
PRESSURE VACUUM BREAKER IN1nAL 1UT PRESSURE VACUUM BREAKER FINAL TEST
pp PSID BgM Opened fat PSID tight PSID
OW got open �� ]] t�eaYed Static
Static PSID
COMMENTS
A... .eq 1- •e. 5 7 1 —
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS COND UCTED BY ME PERSONALLY.
Tester Name (print) D t) n Ch. /fi r Re No. 04, ,R7 7 Time of Day
Taster Si U P/ c---2f Phone No. 7 3 75/5, 5. Date el A21) e.... _