HomeMy WebLinkAbout2003-06-13 Galaxy Mechanical RPZ Test Report REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: Van V ice.. 5 r' ,. Contact Person/Tele
Address: ! `d e6 3.S 5 9 . Al Cit pea-- P k. 14+ State: , r l J. V I ,. Zip
Device. t_ocaton: Ci o j lq l~• u Serve what system: f Q W l . t t' • 6N
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Accouni Number. Serial Number . ( q .4.
7/Pe 12. 7 Z_ wake: III T 1 5 Model: OOq � S�'lze: er . r
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1hs'JI Date: AirGeo Installation Date 'ng��
7 T est Date: IP — (3 — 0 3
Rebuild Data:
Check Valve ' 1 Check Valve 2 Differential Pressure Relief Valve
An
n neat Cis °se GA OSv-Lk
Report
Pressure 4 1 . 0 Pressure 51 . I Opened at •1 osid reCuced pressure.
Oid not open
C :vaned Cleaned Cleaned
Replaced Replaced Replaces
P. Disc D 0i;sc. Upper
E / , • Spring Disc, Lower
Guide Guide Spring
2 \
Pin Retainer Pin Retainer Diaphragm, Larne
:singe Pin
Seat Hinge Pin Lo
Scat Upper
Diopnrogm Diaphragm Uiapnragm. Small
Other. d�scr>be
Other, descfroc Lower
Upper
0 VI Seat
Lower
Upper
Spacer, Lower
Other, deSCribe
(_______ I Sign and date Tag (3 - d 3
( D 2tc T z s ted:
The above is mortified correct. Signed 13�/ — Q
Tested by (Print Name) f � G e
Yj M O cl_ a _l Certification Number l a T
Company Name: Cam' G.`.0. x 5 AA e C4. 4i. i Q _ L License Number o •,> s P:
Company Telephone Number L Q `, ( - ✓/ S' Co ^ 3 .S 5
All sections of this report must be completed. Number of D F- oer Device
S 30
Return to. Saint Paul Regional Water Services First S 30
8 4th St E Ste 400 Devices 2 -21
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9 4114 * • 6G#g'taeeo4 T .ec .
7317 Lake Drive • Lino Lakes, MN 55014
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ATTENTION P""` _"`mac -.) rmA.
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FROM: GALAXY MECHANICAL, INC.
7317 Lake Drive
Lino Lakes, MN 55014
PHONE: (651) 786 -3555
FAX: (651) 783 -9324
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