HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - IL Trash Room 2013-09-04 11:57 INTERSTATE TESTING 7637555365» P 3/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 66304
Phone(763)7444149
OWNER INFORMATION
Shure!Name 1 Sheet Alamo
___4)^ t i:L\ 7 Sole Zip Code Owner's COnbd Noon Toisptirir Number
- J- r ,-1-1 r> }' f - . ( i /) 7 7 S c J
FACILITY INFORMATION
F.... Name Street Address
Oly Zip Cods
Assembly Locator . I ,,
Manufacturer _ Model Serial Number —
Ji Lg. , 47 75 % (-- 1e1 A' 7 % q
Size 3 /./ " Assembly Type alt"- D RP Detector ❑ DC ❑ DC Detector ❑ PVENSVB
egnAL TEST
Pli=tight jr! RP relief valves
0 Leaked �j -z - 0 PSI)
Static ! PSIO Sttbc tight
2 f PSID LJ not
ANAL TEST
❑Clamed ION ❑Closed tight Opened at PSID
Static PSID Static P510
DSTECTOR BYPASS ASSEMBLY INITIAL 1 TEST gllisat❑Closed tight ti Opened PSID
O Leaked 0 Leaked redid not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight ❑Closed tight Opened at PSID
Static PSID Static PSID
PRESSURE VACUUM BREAKER INITIAL TEST PRESSURE VACUUM shiAms FINAL TEST
Air kdet yoke Cbactireb, ,Aldriet.mabs
Opened at PSID ❑Closed tight Opened at PS10 Closed tight
U Did not open []loseired
Static PSID
Static PS10
COMMENTS
/ ri,-� t4yg ) —; , 1
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(Print) D a h ►'1 � / J)•e.- Remotion No.v ro S 3-23 ' Time of Day
Tester Signature (9o-r• frin.-0--e _. Phone No.7(o-� auto .l ed,C_4
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