HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - AL Boiler Room - Make Up 2013-09-04 11:58 INTERSTATE TESTING 7637555365» P 6/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave.NW.
Andover Ma 55344
Phone(763)744-6149
OWNER INFORMATION
Ownsr Name J Sbset Address
krtc Ay 7"-r,a Al ��/4 "1 d Owner's T _�
lip �w Mates
FACIL[r1l INFORMATION 7 I r1'1 A r tm 7 pe..,7 (6 S 1 ) 7 7 S S P 5.!
Name l Street Address
e e i h • _ d C7 a 1. A •• r _ t.;A.
v4 1k A•'1 l-1e, A t < Code ..
Assembly Location /
A I- e/t Zit /2.4 r .s.., %/1'1 I A `1 /' _
w, L � �.c• Model r� � �,Y L _ �l 51 �s a
3iza 3 4/ Assembly Type ILIRP D RP Detector 0 DC 0 DC Detector 0 PVBW$VB
INKTIAL TEST
di tight a •• •,. dght Opened at 4/, U PSID
0 Leaked 0 Leered U Did not open
Static - d PSID Static Q MD VEST
❑Dt ea Airs 0 dosed tight Opened at PSID
Static PSID Sbi c PSID
DSTfCTOR BYPASS assaulLY INITIAL TEST
o C Osed tight 0 Cbe�ed dent �O��e�+ed PSID
0 Leaked 0 Leaked 0 Did not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST •
0 Camel tight 0 Closed tight Opened at PSID
Static PSID Static PSID
pitiunuar VACUUM BIIEAI®t INfflAL TEST -PRESSURE VACUUM BREAKER FINAL TEST
Air Wet vatve glitikatte 4110:611.1162
et P31D 0 CIn sd light Opened at PS10 Cio sed fight
Did not open 0 Leaked Static PSID
Stack P310
COMMENTS c—r
/- 1,.ai i. \pi 1
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) 2)e h rt /h , 11-e.... Regi Lion No.06C3-13 6 i Time of Day
Tester Signature C:2—t 7411- — l. Phone No.76.3 3 Date 2/7_1.91.i 3..
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