HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - IL Boiler Room - Make Up Aug.29.2014 11 :00 AM Interstate Testing 763 755 5365 PAGE. 4/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 55304
Phone(783)7444149
OWNER INFORMAT 5 59 0 i4(3,(L6T..04-$
ION _
Omer Name -* Strsei Mews ' .
k r 1 et n / -/- i'll.t, -c
%its 2P Code Oweees COMMA Poem Toiepiterie Number
•7 r_ )-vi A P4 na tlee,,i7( eL C 1) -7 , 4)- Y
FACESTT INFORMATION
Name \ Street Address r
e • 4 e / 11 . , e o e ,I. , A
City
O' ' 'IV ■< .€ e , •I 1,.._ j-3,,3I u " /2,,in , % frig/44 4 P - / 4g .
Ma nufacturstr - Model Serial Number
, C Y.' L
. .... AMIPIM11.5W1.1111"M $. . I .. ,-- .. 0 ... 0 •?... 1,.,:i—• 0 PVWSVR
INITIAL TEST
ST
...I .,.
.. . ught riftrtight aejaarlYliwaned ), -C P8I0
0 Leaked As 0 Leaked U Did not open
Static f - 02" MID Static OJ PS113
MAL MST
0 Closed light 0 Cbsed tight Opened at PSID
Static PSID Static PS1D
-----------.........-----
•
DETECTOR BYPASS ASSEMBLY INITIAL TEST
BEIN‘RbfiftE
closed tight C—rigged tight PSID
CI Leaked 0 Leaked Ocror atopen
static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed tight Opened at PSID
Static PSID Static PSID
PRiSSURE VACUUM BREAKER INITIAL TEST PREMIUM VACUUM BetAxeit FINAL.me
stialeurnme t,.., 1...„ iAir Inle(vehe
PSID IS Closed light 'Opened et PSID Closed light
nned..,atopen N Leaked Static PSIO
StatIc PSI0
--
.
COMMENTS
••••-
!HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY.
Tester Name(print) D ao" n /21 i i/-e./- Registration No.06'73-13 8 rikir of Day
Tester Signature (9,7,--1-■ frt-e--et Phone No.76.3 Date—isigitg
7q11/ 6/y1