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HomeMy WebLinkAbout2014-07-01 Mid-City Mechanical Annual RPZ Test Report - Irrigation - NEW - Zoro-Wilkins A376240 ANNUAL TEST REPORT REDUCED PRESSURE ZONE BACKFLOW PREVENTERS DOUBLE CHECK VALVE ASSEMBLIES MANUFACTURER Z /t nikae1 MODEL s'S 7C e4 SIZE I G SERIAL# A 'S?(0 240 NAME OF FACILITY VA uC L.i n k. COUNTY (iiASN,r°1 . ADDRESS(STREET, CITY,ZIP) S—E'O O /t) AC licE COAL Acct. f4 E 4 i c SZ6z LOCATION OF DEVICE IN BUILDING g['.S ê WWI- I SERVICES WHAT SYSTEM E e ei A.Ticru CHECK VALVE NO. 1 CHECK VALVE NO.2 RELIEF VALVE (FOR RPZ ONLY) INITIAL LEAKED ( ) LEAKED ( ) OPENED AT4-0PSI TEST CLOSED TIGHT ( $) CLOSED TIGHT ( )e-) REDUCED PRESSURE DID NOT OPEN ( ) DESCRIBE CLEANED ( ) CLEANED ( ) CLEANED ( ) REPAIRS REPLACED ( ) REPLACED ( ) REPLACED ( ) DISC ( ) DISC ( ) DISC.ASSEMBLY ( ) DISC HOLDER ( ) DISC HOLDER ( ) 0-RINGS ( ) STEM ( ) STEM ( ) STEM ( ) RETAINER ( ) RETAINER ( ) SPRING ( ) 0-RINGS ( ) 0-RINGS ( ) DIAPHRAGM ( ) SEAT ( ) SEAT ( ) SEAT ( ) SPRING ( ) SPRING ( ) SPACER ( ) GUIDE , ( ) GUIDE ( ) OTHER-- ( ) BUSHINGS ( ) BUSHINGS ( ) DESCRIBE BELOW: OTHER-- ( ) OTHER— ( ) DESCRIBE BELOW: DESCRIBE BELOW: SPECIAL COMMENTS: ki tw 4 t1Si?. FINAL CLOSED TIGHT ( Y) CLOSED TIGHT (x ) OPENED AT 4.O PSI TEST REDUCED PRESSURE L. DATE `1-1- t 1 SIGNATURE INITIAL TEST BY �cn�, �� 116 . REPAIRED BY DATE SIGNATURE FINAL TEST BY: MID-CITY MECHANICAL DATE 7(-/4 SIGNATURE r TT 1 9103 DAVENPORT ST. N.E. BLAINE, MN 55449(763) 786-8617 PHONE CERT. NO. b401COts-t (763) 786-8640 FAX