HomeMy WebLinkAbout2004-06-16 St. Paul Regional Water Services RPZ Test Report Jun 24 04 08: 44a p' 4 1
. 1
REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: e-s., " _`- Contact Person/Tele (
lWdress: /4/ 435 5 -7 -0- 0. city: ?k_ 14+5- State! .�11�, _Zip: j
Serve what system: `Gtil h i r r;yGth e;Ark �
Device Location: ���r1s� �s Sit�' J
Account Ntrnber. Serial Nu 1, b -
D tvfakcW t tit r13 Model:' � !-Size:
2%S'.21 rare: Air Gac Installation Cate
R Test date: j <b (°`J
Rebuild Date:
------ Check Valve i+1 Check Valve.1:2 Differential Pressure Relict Valve
Annual
Reps Pressure -$ Pressure 's Opened at 4. -.)mid rduccd pressure.
Oid not open
Cleaned
Cleaned - Cleaned
Raced replaced Replaced
R • G c Disc Disc. Wooer
E • Spring Spring Disc.Lover
(PR Guido
Guide Sprang
Pin Retainer Di2phragm,lie
Pin Rctaw�r
liir+g�:Pin v Lower
,isn:t!Pin UpGer
Seat Diap Diaphragm Diaphragm.Small
Diaphragm S Other.dew-lee Lower
Other.describe
Sr3r:
V\O�1�' Lower
Upper
Spacer.,Lower
Other.descnoe
f S, ) Sign and date Tag
The above is certified correct. Sighed t A...1 0.A"4-'' ^ ,���
-- 4,• czrtirication Number "y_
Test`s by(Print Name) 1?.� Cw t'r C'.y�
' r r 1 Y�� Licens.. Number � `• � l P•
Ccinpany Name: � t" �-X L
r
Company Telephone Number [s? 5 l ' 7 � to 3s � ----
Number of 44yiC�S Fee der ✓vier
All sections of this report must be complete
Return to: Saint Paul Regional Water Sery 5 30
First
es Device✓2-21 S 25
8_
• . am.St E Ste 400 -A^' 15 vnri ,..or c 1;
y. •d 85.9L-884-1S9 ITapoW dOb :LO bO LT unr