HomeMy WebLinkAbout2002-07-02 St. Paul Regional Water Services RPZ Test Report 07/08/2010 13:40 6517839324 PAGE 02
07/01/2002 22:57 6514848 MODELL /•-■r PAGE FJr
... REDUCED PRES. iJRE BACKFLOW PREVENTER TE REPORT AND
TESTABLE DOUBLE CHECKS
SAINT PAUL REGIONAL WATER SERVICES
Service Name: V aJ.1-e \I it• A rifkr►,s- N. Contact PersoM'ele /
Address: 1 q 7 2 5 7 li• 5+ City: c Pk• WS• State; id 4.A Zip:' .._..
Device Location: ib,_ tom$ i s Serve what system: 14 Le:r. I rdr i 9 flit 4ri.
Account Number J Serial Num r. 45-93 q 1 l`"
Type: P
ft ke:Lail K f n s Modell 15 XL:Size: - ,►
Install Date: Air Gap Installation Date ._
Rebuild Date: Test Date:
Check Valve#1 Check Valve#2 Differential Pressure Relief Valve
+
Annual C.A.0S ' , al:o .Gk..
Report Pressure 77• 1 a Pressure 4. •9 Opened at3 ' i psld reduced pressure,
Did not open
Cleaned Cleaned
Replaced Replaced Replaced
R • Disc ___ Disc Disc,Upper
E . Spring Spring Dec. Lower
P - Guide Guide _ Spring
A Pin Retainer Pin Retainer Diaphragm. Large
I Hinge Pin .. Hinge Pin Lower
Seat Seet Upper
R Diaphragm.Small
Diaphragm Diaphragm 5
Other.describe Otter.describe Lower
Upper
Seat:
Lower
w.
Upper
. Spacer,Lower
Other,describe
Nil sign and dace Ta$
_I - per
The abCVe Is Certified correct. Signed LA.,‘"--- 6 ./1__ DateTested
'Foisted by (Print Name) b r\ P3 , Mel`el e i,I Certification Number C1 Z 0 7"
Company Name: , ' ■ g A 1 4_ . C.-6. ,,, License Number 1-x-7 ?,--
Company Telephone Number 51 ` -1 g 6 _ 3. 'S1
All sections of this report must be completed. Numger of Devices ,e9 oer Device,
Return to: Saint Peul Regional Water Services First 5 30
2-21 5 25
8 4th St E ate 400 � � and over >S 15
Saint Paul, MN 58101-100. .
Return with fee: payable to the Board of Water Commissioners, ' —7 bi)
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