HomeMy WebLinkAbout2003-06-13 St. Paul Regional Water Services RPZ Test Report REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: 0.-i`-P-Ai VI;,.. Go..... A.ev∎5 Contract
Person/Te le .--
Addr s: 1 ` 7 $ 5-7 ' Sf city: O a-k-TL4_rrj.S state:/N J
Zip: •
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Device Loca�on: Serve what system: S- 1
Account Number.. Serial Number: a431 -7S
-ripe: -1: P Z" Make: 6,0.4 l►-ts Model: aria Atze: II
Instill rate: 7 Air Gao installation Date 't^o n'--'
Rebuild Oa;e: ? Test Date: to--( 3 C .
Check Valve it1 Check valve M2 Differential Pressure Relief Valve
Annual G ( o S-e CJA DS'"c.L.
Rep 1 Report Pressure 9 • d. Pressure • 1 Opened at 3-4 osid reduced pressure.
Did not open
C:caned Cleaned Cleaned
Replaced replaced Replacea
R _ Disc Disc Dec.Upcer
E ' Spring Disc.Lower
�n9
? Guide Guide Spring
Pin Retainer Pin Retainer Diaphragm.Large
! Tinge Pin
Hinge Pin LOW:r
R Scat
Seat _ UMer
S Diaphragm -
Diaphragrn Oiapnragm.Small
Orner,describe Other.desc.CC Lower
Upper
h b n E'/ Seat:
Lower 1
Upper
Sparer.Lower
Other,describe
( I Si r:and date Tag •
(( 1 D�cTesteC: � �I 3 - �
The above is certified corned. Signet Lam,/ - (�
Prnt Name) (k r r e'.v•N V2-, _. � .c1(e-L i Certification Number l Z1 0-1-Tested by( Oda-Ccmpany Name: 01 )l. A e. .4_14.t c",,..''""QQ -,
am' ,71.t!14 . License Number S"$S-1 P
Ccrnpany Telephone Number L>t`J I - 1 Ls - 3 s-__5- -y
Ali sections of this report must be completed. Number of Devices F.a oer r rrvice
Return to: ' Saint Paul Regional Water Services First S 30 Devices 2 21 S 30
8 4th St E Ste 400
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