HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - LL Mech Room - Boiler Feed Aug.29.2014 11: 02 AM Interstate Testing 763 755 5365 PAGE. 9/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn.55304
Phone(753)744414$
OWNER INFORA jATSN____,________,___, . .
• • NOM -- Street Address
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-•to Dp ••. Disnisli •• toot Perim Telephone Number
3-1 kyk. A•-1.11 'fro •,1- ( ec t ) 7-7 c--- ccFACILITTY INFORMATION
v, Stant Address .7
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Fociplyizv;I:7.r...ti / 3 C-, ' --
City 23v Code County
0 I, k A-4 1441.1,A. 1-c
Assembly Locoson
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, Re 1 I 414- rl--4::-0--- -7
menutectvor 4 . Model Wei Number --
Ck j 1 ri i■4., ,-25X4— _ 306‹ V 6.
Size 1-a Assembly Type ce6--Rp_} 0 RP Detector 0 DC 0 DC Detector 0 Plf1341/8
Its17111AL
RP relief xahnt , .,.
dosed tight ngfe tight at z---- PSID
[3 Leaked (-) 0 Lsieked airdKi not open
Static a 1 (2...."P81D Static 0 )C._ PSID
FINAL TEST
Clamed tight 0 Closed tight Opened at PSID
Stedc P810 StatIc PSID
--------
DETECTOR BYPASS ASSEMBLY INITIAL TEST .
siLiir 4acit
RP reaef_yelse
Iebios‘ii-light Cgired tight 1::: wed et PSID
°Leaked 0 Leaked U Did not open
Static PSID Static PSID
-
DETECTOR BYPASS ASSEMBLY FINAL TEST - -
0 Ciosed tight 0 Closed tight Opened at PSID
Static PSID Static PSID
P. IMRE VACUUM '7. ■.J. IN/TIAL TEST : PRESSURE VACUU BREAKER FINAL TEST
Air inlet salvo 11!1.:. .,• t.Li' INEM141i12 2mdc Valve
PSID •Closed tight .Opened at, no u Closed tight
a)6014inestropen U Leaked Static PSC
Static PSID
COMMENTS
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) n e I, p- /L1 illt_6.- Registration No. PI r 0 4,5 5.13TIrae of Day
Tester Signature Y g/ -1 Phone No. (763) 7444149 Date Fit>41/4/