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HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - Fountain Room Aug.29.2014 11: 01 AM Interstate Testing 763 755 5365 PAGE. 7/ 14 Cross Connection Control Device Performance Test Interstate Testing 2140 141st Ave. NW. Andover Mn. 68304 Phone (153)T446148 OWNER INFORMATION . • . . Name �t Address .i' •mte :.. •.e chimers e. .•of • • •rte» ,.r ,. T1 A P-14-1. S '1-r c, ..1 ( 6 C l ) ?7 S fib''S' FACIVTY INFORMATION Fet�f� 1/ [�i`1 ` �it�M Address a ((( $_ � 3c7 �" 50 T-ck ST C aty , //, z Code t1ou11tl+ Ft' 4h+4 . 1 yhoC.t-4-- 5-744/ /- P nut ectisei \ Modal Serial Number W I /1�/'.—.4 _ `may S7 c X<— 30. 72 P96, , 81r.e 3/2.1 Assembly Type erBP D RP Detector 0 DC Cl DC Detector 0 PVBI$VB t MAL TEST klelaad light e6= �Qyer d t 3 Cl Le*ed (,.� / 0 Laiaked�ht CJ Old not open MID FINAL Static �S ' X� P810 Static 0 MID C ee �M O Closed tight Opened at P810 stead P810 Static PSID DETECTOR BYPASS ASSEMBLY INITIAL HEST • R raabt e s ill Ca—To—s—ed tight W GI (Cooed eght Open ed et PSID °Leaked © O brd not open Static MD Static PSID DETECTOR BYPASS ASSEMBLY FINAL TEST 0 mead bM P81D Static �M PSID Opened at PSID PI SURE VACUUM SREAxgR ROW.Yen ' PRESSURE VACUUM VACUthe BREAKER FINAL TE8T AMLio !I.,,,•,. ,i,:.�, Ail: Opened at P810 �i Closed light Opened at PSID D( o ht olr no tops„ •Leaked static MD Static PSID . AW COMMENTS . "'° / U i 4- 4 2 4 i 7 4, Ti-- • I HEREBY CERTIFY THE TEST RESULT$ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Teeter Name(print) _ e r t r 1 t 1/.t.ti Registration N0. A T o 6<33A Time of Day Tester Signature Phone No. (763) T44-8149 Date PAZ/1 y