HomeMy WebLinkAbout2013-08-29 Backflow Preventor (RPZ) Test Report - AL Trash Room - Garbage Chute Rinse 2013-09-04 11:59 INTERSTATE TESTING 7637555365» P 7/13
Cross Connection Control Device Performance Test
Interstate Testing
2140 141St Ave. NW.
Andover kin. 56304
Phone (763)744-4148
OWNER INFORMATION
Omar h > Sees!Addeee t A y '74-.. > ri jc) i i 7' "1,1..e
State Zip Code Danes Conflict Person Telephone Numliar
F J 1 C 1 L n'1'INFORMATION
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Nifty Name ., Steel Address
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Manufacturer
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size 3I‘, "' Assembly Type CARP• 0 RP Detector 0 DC ❑ DC Detector ❑ PVWSVB
WTTIAL TEST
/ sT d k RP Mehl** ' . d
tipdt �. • , tight Oyerted at FM
❑Leaked /v ❑leaked d U Did nOt open
Slatic l
MD Stalk PSID
AWL lEST
❑closed light O Cased ken Opened at PSID
Steyr PSID Stalk PSID
£ 1YCTOR BYPASS ASSEMSLY INITIAL.TES
PF'fellet valve
Clawed Ilpht gaired tilt Opened et PSID
❑Leaked 0 leaked 0 DId not open
Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY ANAL TEST
❑Closed Ws ❑Closed data Opened at PStD
Static PSID Slade PSID
PRESSURE VACUUM BREJNQ9t IINTIAL TEST PRESSURE VACUUM BREAKER FINAL Tt!ST
AaMet veMe CDNOLDIttle iAir kdet valve _Y_
per d at P81D 0 Closed Deg Opened at PSID U(s ed tight
CI ol�a+got open ❑Limited Static PSO
Static PSID
COMMENTS °'_'_�
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED 0Y ME PERSONALLY.
Teeter Name(p r i n t) D O 1 1 h 1 2'1 r /!be a Registration No.v(o S3 3 R Ti was Day /' 1
Tester Signature `_9csw� • _. Phone No. 3_____ Dam-'!�-/4/ )3
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