HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - LL Soiled Laundry Room Aug.29.2014 11: 02 AM Interstate Testing 763 755 5365 PAGE. 8/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn.66384
Phone(763)744-6149
OWNER INFORN_ATION
2e Name
,r .. h■-/71-"ett 44
/311 e 1 4
root Address
State 2Ip code Omura Ombra Poison Telephane Number
,_-r t .4 r sr,c„7
FACILITY INFORMATION
Skeet Address A' V.,2X
• 7÷t,-) f/ Li A i fri c-- ) 0 '" fr.
lip tole Cow*
C -t
Airy r:.Pr‘. , 4 I CJ
1X
knuf. stir V't I 1..,411/4/*Iatfr. A-a11111 tati "/ iglifil0:711p4 It i IV c'-es ...
ko•-.) 1 Lk I•-% S 51'7 c y L
S i z e 3/ '' Assembly Type 0 RP 0 RP Detector 0 DC 0 DC Detector 0 PVB/SVB
INITIAL TEST
allgaitht t!":77... , tight Belflibditel2einad 3 ' Y PSID
OtatiLefed 3, < 0 Leaked Li n
Old not open
MID Static 0 PSID
EBLAL IEST
pawed tight 0 Closed tight Opened at PS1D
Static MID Static PSID
DETECTOR BYPASS ASSEMBLY INITIAL TEST .
traw& BEmbbm
sti
0 Cloeed light CgIbMISisied tight PS1D
0 Leaked 0 Looked RDIdednoattopen
Static, PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed tight Opened at PSID
Static PSID Static PS1D
misuse VACUUM BREAKER INITIAL TEST • PREISURE VACUUM bRilocea mit.TEST
81Llobbsto littrioNt.mot
=lir P&p I Closed light 'Opened at PSID CloRlitialed tight open •Leaked Static PStD
Static PSID
NV
COMMENTS '
77,, sr_... .
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Teeter Name(print) Do,,, ,- PI , I le I. Registration No.06 C3-23 8 rim.of Day
Taster Signature c 2....."-, fr-t_e_e... Phone No.763 Date 21.141/ y
7v4f (fiqq,