HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - Boiler Room - Boiler Make Up 2013-09-04 12:00 INTERSTATE TESTING 7637555365» P 12/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 66304
Phone(763)744-6149
OWNER INFORMATION •
Owner Name Street Address
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FACILITY INFORMATION
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INITIAL TE$T
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FINAL 7T
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Static PSID Staffs PSID
DETECTOR BYPASS ASSEMBLY INITIAL TEST
1 RP renal wire
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Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY ANAL TEST
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Static PSID Static PSID
PRESSURE VACUUM BNEAIaR emu.TEST PRESSURE VACUUM BREAKER FINAL TEST
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COMMENTS
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) a,1 n Ph 1 1 le i- Registration No.0 6 S3-23 Time of Day
Tester Sionature C_24,-,-, _ fie--c—et fiel—c—et Phone No 76 3 Date 549 //-
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