HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - Pool Fill Room 2013-09-04 11:58 INTERSTATE TESTING 7637555365>> P 5/13
Cross Connection Control Device Performance Test
Interstate Testing
2140141st Ave.NW.
Andover Mn. 56304
Phone(763)744-6149
OWNER INFORI$ATI94 _
O vier Name ! Street PActvea
- - /'1` t' - I
r Stag Lip ••, Owners Contact Person Telephone*sneer -
7 / m Aen, 5 '�pr,7 ( 4C /) 77S ).- c'O 'i
FACILITY INFOlATIOM _
F,,• Name •, Street Address L
e i e ) 17 ' `�_, d7 CJ <' f- 1 'A 1 i f' l� LA.;- C
n
0 N .4 _ �Jti /� 1`�e/r f
DP Coen . . . --
���Location Pcni l
� // J/�u --I-%,
manuf.d.w,. Model Serial Number
(A.) 7 LK/ ri s , 7 .A." L.- / 3a -) s 2
Sae, I " Assembly Type 0 RP ❑RP Detector 0 DC 0 DC Detector 0 PVBISVS
INITIAL TEST
°Closed light U Cbwed tight O��ened of PSID
Static a P310 Static PSID U
FINAL:iesT
❑Closed lots ❑Owed tight Opened at PSID
Static PSID Siolk PSID
DETECTOR BYPASS ASSEMBLY INTTTAL TEST
sT bath RP IiNMt Malls
0 Closed l uta 0 c7osea tl l Opened et PSID
O Lsaiod ❑Leeloed ❑Die not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
❑Cloned tight O Closed opto Opened at PSID
Static PS1D Static PSID
PRiIURir VACUUM BREAKER Ifii1AL TEST PRESSURE VACUUM BREAKER FINAL TEST
Air inbt with a iAM ktlat viable
Opened as PSID ❑Closed light •Opened at PSID U Cbssd fight
p Did aol open LI Lulled Static PSID
Static PSID :
COMMENTS
/ ' Li&t i-
HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) 7J o A n 121 , 11- A. pia,No.04)S 3-23 &Tape of Day
Tester Signature C.2,• _/1-&---et Phone No.76.3_—.. Date ./).9/13.
7c' / V5