HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - Boiler Room - Chiller Feed Aug.29.2014 11: 04 AM Interstate Testing 763 755 5365 PAGE. 13/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 66304
Phone(763)744-8149
OWNER INFORMATEON . .
- ___________
Dow Name Strada Address
A . 0114" ''' 4
'tato .,• Cods Owner*Contact Parson Telephone imumber
15 rin A fr It/ 1 f 1-ci ( 6C /) 77 'c c ' c '>
FACILITY INFORIAA11014
, Name ■ Street AddreeS
<q s- Ci ,A)&Lei A.-I
ate 4." ... County
OAkul?, Ask 141 4 .74-
Assent*
fezt-e----
is.tonutactzrer j r, '• Medd Number
LA.) I LI< 1 C , 7 c 4._ :. -6 C 9
Size R 4 Assembly Type 14151P--1 D RP Detector 0 DC 0 DC Detector 0 PlitideVIS
INITIAL.TEST
4t5 ) ...A..* ....,
gelfilKtrt Illiened 3 . k MID
0 Leaked -c1 , ? I Waked u Did not open
Static `----- PSID Static o e----PSID
ROW WSJ
OCIosecitts 0 Closed tight Opened at PS10
StatIc MID Static PSID
DETECTOR BYPASS ASSEMBLY INMAL TEST •
gentfillELE
CIPP°16med tIght Clcirgtdiesed tight PSID
0 Leaked 0 Leaked )etilidednolitt open
Static PSID Static P810
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed dght °Closed tight Opened at PSID
Static 13810 Statk PSIO
PRESSURE VACUUM BREAKER INITIAL TEST PRESSURE VACUUM BREAKER FINAL fEST
litchlaioka •:1... .... 1 IA Itikkataitb2
PSID i Ciosed tight .Opened at P810 CaRlifebt2
aled tight
ridiednoitgopen 111 Leaked Stc PSID
Static PSID
•
COMMENTS
f"---
d, Afl ...I..r2-01-.0- y_02..5 cr------•
I HEREBY CERTIFY THE'TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED EtY ME PERSONALLY.
Teeter Name(print) 7)d,,•■ In ill i /i-e.).- Registration No.0 6C3-23 8 rl'Inr of Day
Tester Signature c 26,-t-, I---L-e--et, Phone No.76.3 Date *212y
7(1i( ',i'41,