HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - Boiler Room - Chiller Feed 2013-09-04 11:59 INTERSTATE TESTING 7637555365>> P 9/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn.56304
Phone(783)744-6149
OWNER INFORMATION
Owner Name . Street Address
) i a . A i • 1. 4 koppe
• .......
tate Zip Co;le Owner's Contact Peion Taieurisne Number
1-1 AILq,t2. 7 P<A ( 6Ci) 77C 'Ca) 'S .')
FACILITY INFORMATION
■ Street Adlress
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4 I C 0 ,A-)e•bi Pk Pge/Z•t..) .:( AT
City Zip Code Carey /
// Y4'/,:A t< . ,.
Asserribdy ....
Li '
Manufacter ... Model Serial Number
W ; Lk 1 ns , , C _)Cl—
Size /5/' Assembly Type CLARP--, 0 RP Detector 0 DC 0 DC Detector 0 PIIBPSVB
— ---
*JITIAL TEST
BEIEIStanSt )
tight gvned at .> ' CP PSID
0 Leaked ) ;73 0 Leaked
.... U Did not open
Static PS1D Static 0 rpsi 0
MAL ELosT
0 dosed light 0 dosed light Opened at PSC
Stalk PS10 StatIc PS10
DETECTOR BYPASS ASSEMBLY INITIAL TEST
1_chedisT eitefaS MiTglilltre
00 C11-7--leed We 0 Cbsed Iight at P310 0 Leaked 0 Leaked redid not open
Static PSID Static P810
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed 1101 Opened at PSID
Static P310 Static PSID
PRESSURE VACUUM BREAKER INITIAL TEST PRESSURE VACUUM BREAKER FINIAL TEST
&Winking** OHL!** INLInItintIn
MD CI Clasen light Opened al PSID 81.2100seilte2ight
23eoridiedaolitopsn 0 Looked Static PSIO
Static PS40
COMMENTS
ik.-17./. e*4)41 I'' CT;I C:t
I HEREBY CERTIFY THE Tg.s.r.RESULTS ARE TRUE AND THIVIEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) D a A P-1 pi , j) ■• Figistration No.(26C3-2 3 8 riirae ot Day
Tester Signature ( 2o -.2o -. 174—et_ Phone No.76 g Date