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HomeMy WebLinkAbout2012-08-22 Backflow Preventor (RPZ) Test Report -Garbage Room 2012 -08- 2313:56 INTERSTATE TESTING 7637555365» P8/13 Cross Connection Control Device Performance Test Interstate Testing 1 2140 144st Ave. NW. Andover Mn. 55304 Phone (763) 744$149 OWNER INFORMATION Owner Nana Street Address r C M L. C �7Jp m Telephone Nu er Ti r%-, A P ►,.i j 1 r.4 e, (6 ti /) 7 7 •C S)? S ') FACILITY INFORMATION fory Name s. Stan Address i , w c J/ /9^ lnv O •,t) L9, p � kwdr 1 City Do Code Cams As�amGly pY z 4 i 4 / Merx fe _ i. 5 G 4 A ,No , `' )2..,."-, ' gyp, Number 11 /P C 57c x 4. W l ,,/] <585 Sire 2)4" Assembly Type B RP Doppessapr 0 DC 0 DC Detector 0 PVBISVB INITIAL TEEST Old not open RP ralUt,rai„a II1eosW Q�6pht r pened el • " PSID eac.____ C3 Static PSID Static PSID FINAL 0 OgP 0 Closed tight Opened at PSID Static PSID Static _ PSID DETIECTOR BYPASS Aii1B1SLY INITIAL. TEST REMILIIETS Opt p Ct d tgM PSID ©L•efted CI Leaked Did not open Static PSID Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 art Opened at PSiG 0 Closed tfgM Static PSID Static PSID PRESSURE VACUUM SNEAKER INmAL TEST : P i • • RE VACUUM BREAKER FINAL TEST Mr nlet vows ( ,ene at PSID Closed Light Opened at PSID Q(aossa tight MID l DW aot open State PSID ,� COMMENTS !�I y...e4 /- 7-1-.4-1-7--- 1 HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name (print) 00)1,7 / j /1d, Registration No. Or., , Tlrae of Day Teeter Signature (j1) '2 L--' I Phone No. - 7/. 3 7 L s:,* Dabs 9 / 4_111_2 `1