HomeMy WebLinkAbout2014-08-26 Backflow Preventor (RPZ) Test Report - IL Trash Room Aug.29.2014 11: 01 AM Interstate Testing 763 755 5365 PAGE. 5/ 14
Cross Connection Control Device Performance Test
Interstate Testing
2140 141st Ave. NW.
Andover Mn. 66304
Phone(763)7444149
OWNER iNFORMATION i- 1 5c10 J\kff WLell ?ILL1/(e5
Ow?Woe Street Address
,..! T isispluon Number
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FACtutY INFORMATION
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PSID Stade PSID
FINAL'BEST
0 Closed light 0 Closed tight Opened at PSID
Static PSID Static PSID
5DE7ECTOR BYPASS ASSEMBLY INITIAL TEST
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CiPred light 0 Closed tight P810
0 Leaked 0 Leaked Odeprilded not at open
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Static PSID Static PSID
DETECTOR BYPASS ASSEMBLY FINAL TEST
0 Closed tight 0 Closed tight Opened at PSID
Static PSID Static PSID
PRESSURE VACUUM BREAKER INITIAL TEST ' PRESSURE VACUUM BREAKER FINAL TEST
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PSID all Closed tight ,Opened at PSID CR2folafiMle 112d tight
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Static PSID
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COMMENTS
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I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CO_IPIESLOYSIE PERSONALLY.
Tester Name(print) D 0 i. n PI i /4 be ,- Registration No.04)C 3-13 g irTlme of Day
Tester Signature C.,.2-•--1-x. "1-c--e../.. Phone No.76.3 Date V
519-4/1
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