HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - LL Mech Room - Irrigation Aug.29.2014 11 :03 AM Interstate Testing 763 755 5365 PAGE. 10/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 56304
Phone(783)7444149
OWNER INFO' , AT •,
• • •
Nor Street Address
rei 6 4 +4,-,-i 5 s.-1,
State bp Code Caller's Canted Poison Telephone Number
T"- At A i, .-V rz},e. (a c) ) -7 7 c s -5 5
FACILITY INFORMATION /
Fogby Name ,
Street Address
La
City „ '- Zip Code County
o< k 14 4 Iqe/i 4 -1-1
Amorality Lawson
1...D__€- Al.-e<is Re.,4 PI--.. 1 r i” 15 q• . /c3 l'‘.
manufacturer •-, $erial Number
L.) sitot<. , 5) 4 Y'Z-- 3osc 1./ -7
Sim / /2- Assembly Type 41T) Cl RP Detector 0 DC 0 DC Detector 0 PVB/SVB
INITIAL TEST
sr
RP relief valve
?lec:adrsed tight friztatight
at :1 - 2--PSID
O Leaked . p 0 uaked ErMitt open
Static MD Static 40 iL PSID
FINAL 1EST
0 dosed tight °Closed tight Opened at MD
Stalk P810 StatIc PSID
DETECTOR BYPASS ASSEMBLY INITIAL TEST
si_r_sbla
RP rehet valve
0 Closed tight ga-Srlsed tight Cened at PSID
O Leaked 0 tasked 0 Did not open
Static P810 Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed tight Opened at PSID
Static PSID Static PSI D
PRESSURE VACUUM BREAKER INMAL—WAST PRESSURE VACUUM EIRPJUcER FINAL TEST
Air inlet MVO Adahitlabe2
PSID CloRM seiLlbtitht Opened at PSID 8troxiott
2)1inednOt 0 Uadr,ed Static PSID
Static P810
•- --,.......
COMMENTS
( r 5.1---
I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Teeter Name(print) De is".. pi , 1 i-e A-- Registration No. 1,ro f 3.),, Time of Day
Tester Signature (--9„.„ ri-L_Tox__, Phone No. (783) 7444149 sate 04125/