HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - Boiler Room - Outside Garbage Area - Garbage Rinse 2013-09-04 12:00 INTERSTATE TESTING 7637555365>> P11/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 66304
Phone(763)7444149
OWNER INFORMATION •
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OM Name Street Address
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te Zip Code Owners Contact Person Telephoto
)ty Number
• , i ( 6 C 1) 7 c y c e)
FACILITY INFORMATION
fee&Name , Stroet Address
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City 'rip C4:slo Casty /
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manufacturer i N Model Serial Number
Strom Vie 4 Assembly Type (g-RP— 0 RP Detector 0 DC 0 DC Detector 0 pVB/Svg
• ....
INITIAL TEST
iart=gT light '.11 Closed tight RI'ref U, o
at PSID
0 Leaked 7 y • : . , . ok---, al"ornot open
Static MO Static PSID
FINAL lEST
0 Closed tight 0 Closed tight Opened at PS10
Static P810 Static PS10
OSTECTOR BYPASS ASSEINLY IMMAL TEST
l_sbetli slimils BEcellebsbot
0 Ooskl tight 0 Closed tight PS10
0 Leaked °Leaked 171d at notopsn
Static PS10 Static PS10
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 as tight Opened at PS1D
Stalk PSIO Static PSID
PRESSURE VACUUM BREAKER INITIAL TEST PRESSURE VACUUM . ... ■J FINAL TEST -----
AILiDieLake itktietiteke
PSIO Cirs‘1212ted IgN Opened at PS11) EfeloseLltillight
ardednotatopen Leaked Statk PSIO
Static MD
COMMENTS
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND'THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) D 0 ii n PI t //-e. fr. Registration No.0 6 f3-23 8 I Time of Day
Taster Sit:Mature (9:-.,--1-‘ - fri-e- Phone No.7 6,'3 _ mg. 8 La, I d
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