HomeMy WebLinkAbout2012-08-22 Backflow Preventor (RPZ) Test Report - Boiler Room - Boiler Make Up 2012-08-23 13:56 INTERSTATE TESTING 7637555365» P9/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover ltAn. 55304
Phone (763) 7444149 1
OWNER 8NFORMATION
Or Name y Street Address
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• Mate Zip Code Nava Contact Person Telephone Number
•; 7", ,•,.-, A a !I ; 7 r c d, j & ` ' f 7 -7 .c -JP ' ")
- FACILITY INFORMATION
rseay Name Street Address
OW Zip C C m
0 14/C i // 11r� (. A — �1
/ LociYo^ R c / z . , ,` ! . 2 ! - � _ � ! � / 3 1 / L "0 / ,.,, - ) 3 ° / l p � A.... L�r112:' '- t me . Serial Number
Ma :7 1 74 / .;"7 C I , .7 < ' 4 -- 6 ,, v
Size 3/9h Assa ably Type diRlc' aRP-Debeetes 0 DC 0 DC Detector 0 PVB/SVS
IN TEST .. _ RP raiid> YtUvs
S el tight ti t t Qpe r i ed et P S1D
o Leaked q 0 Leaked ❑ Did not open
Static l r PSID Static PSI0
MAL 'MST
Closed ttht 0 Closed tight Opened s1 PSID
State PSID Statie PSID
DiFECTOR BYPASS ASSEMBLY INITIAL TEST
BEEdittnihtv
U Cil ed tight U �sed tight O at PSID
O Leeiced O Leaked O Did not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 goad tight Opened at PSIo
Static PSID Static _ PSID
PRESSURE VACUUM BREAKER INITIAL TI.ST d� " PRESSURE VACUUM BREAKER FINAL TEST
Air Inlet d v t PSID Clowd light Opened at PSID U Closed tight
U Old trot open Leaked Stade Ps10
Static PSID
COMMENTS -
(- 3S - ' L i a r.' . HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY,
Teeter Name (print) Dell e7 /he / lG.l- Registration No. Ut, , "TeS Time of Day
'"aster Signatures FrZ-7 c —,�J Phone No. - it 3 JYY G,i s«) Date 7 )4 2–