HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - IL Garbage Room 2013-09-04 11:58 INTERSTATE TESTING 7637555365>> P 4/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 56364
Phone(763)7444149
OWNER INFORMATION 4 -
Owner NM* Street Adresse
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Sado I. Code I .e Contact Person— Teieplione Piunstisr
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FACILITY INFORMATION
F Name
• Street Address
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• 1 LK 1 PI 97 5- yc. 10272 ) (1 /
sal) 3j y4 Assembly Type :I • 0 pp Detector 0 DC 0 DC Detector 0 pvaisve
ROM/TEST
cteck .i.I-IT Wit . light 213121jalte2ened d - '
0 Leaked 12 y 0 UMW/ U MI not open
Static P810 Static K PSID
FINAL'REST
0 Closed lots 0 Closed tight Opened at PSID
Static PSID 3tc PSID
DETECTOR BYPASS ASSEMBLY IPOTIAL TEST
r_GOOIS REP relki_vitive
3TCH!111511 tight 0 aosed SOS P840 0 Leaked 0 Leaked 317sl a
iti Inottopen
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Owed OW 0 Dosed lot Opened at PSID
Static PSID Static PSID
PRESSURE VACUUM BREAM INITIAL MT PRESSURE VACUUM BREAKER FINAL TEST
Atiohltmatet
Check vat AkkittIette
,PSID Q Closed tight .Opened at PSID CaR2Glealted tight
aggiviiled0Oropm 0 Limited Stalk PSID
Static PSID -
COMMENTS .
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I HEREBY CERTIFY THELTEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester None(print) 1..)4.h P1 Pr/ / /1-e i- Registration No.06 C3-2 3 iii / Tinto ot Day
Tester Signature (2e.---... ____.
.. _ Phone No.74 _ nate
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