HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - IL Boiler Room - Make Up 2013-09-04 11:57 INTERSTATE TESTING 7637555365» P 2/13
Cross Connection Control Device Performance Test
interstate Testing
2140144st Ave.NW.
Andover Mn 66304
Phone(763)744-6149
OWNER INFORMAIRR .
(316•Arr Name Street Attareee
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State Tip Code Orwrars Contact Parson Talap►vn Neseber
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FACILITY INFORMATION
F Nen'►e Street Address
e . ..e .1 e-1) 1.1<' ccit;° 0 _A-)e' ec- 1.Aii 0A 14141--•;°07
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$peal Number- mood�t/gin< `5 , c )7 L. / 2537 ,
Size 3 /y " Assembly Type B'RP/ 0 RP Detector 0 DC 0 DC Detector 0 PVe1SVB
BYTIAL TEST
�7 . tight opened at PSID
o Leaked 0 Leaked 47_, Did not open
ANAL TEST
Static • , PSID StsBc PSID
❑Closed Opt ❑Cbeed NO Opened et PSID
Static PS10 Static PSI D
DETECTOR BYPASS AMY MITIAL TEST RP nttisf wMe
1 Opened et PSID
OLO light redid not open
�.d ❑Leaked
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
❑Closed tight ❑Owed Ws Opened at PSID
Static _PSID Static PSID
PRESSURE VACUUM dRIEAICER INITIAL TEST ; PRESSURE��,, • .��VACUUM BREAKER FINAL TEST
PSID U tight • Opened at PS1D CIO
O Sed tight
U f_Old not open •Leafed Stoic PSID
Static PSID
COMMENTS
1 • i+. `1 A," 1; —
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) IJ a h h Th i 1 J J` RpiWation No.06'5'3-23 R rTit se of Day
Tester Sioneture � .._._Al... -..___.._. Phone No.7._(&3______ Dabs 9../•,\-5. i 1
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