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HomeMy WebLinkAbout2015-06-01 Roto Rooter RPZ Test Report 06/18/2015 14: 54 7635193932 PAGE 01/01 • ROTO ROOTER ER PLUMBING SERVICES GO. BACKFLOW PREVEN TION (RPZ) TEST REPORT 14530 27th Avenue N. Plymouth; MN 55447 763-559-3522 . r' C� a0 S Device Location Ar0.w c L-- Customer .�t/d1y11�s'� .,.� ______ Site Address 026./ Sair4 cm %//t/ System Isolated yeS • •City/State j ,!4N •) Q8 _ Install Date —_ Contact Person S } Overhaul Date 3 c:VD 13 Phone Number Test Date . . (0// / Type of.Assembly: RPZ 1gl OCV❑ _ • A ., , ..Make Ahlideacj. Model 92 T Serial Number /94yaci Size 3�y New Replacement, if applicable: Make Model Serial Number_ Size CHECK VALVE#f,1 RELIEF VALVE CHECK VALVE#2 CHECK VALVE;#2 BACK PRESSURE CONFIRMATION ❑ Leaked Opened at: 3' 1_____ psi ❑ Leaked ❑ Leaked yl Closed tight Did not Ken_ CH Closed tight [`Closed tight - ' • ' •Ditfi i iligl pr�'Scure:"- —• '-' -�e'!�'-- '- " -'Differential:pressure;----'--•Differentiai-pressure!- ---- •- g-/ --- psi — --- --- —r=! psi _ a y _ psi _______ El Cleaned only ❑ Cleaned only ❑ Cleaned only Replaced: Replaced: Replaced: • ❑ Rubber kit ❑ Rubber kit ❑ Rubber kit ❑ CV assembly 0 RV assembly ❑ Ci/assembly or disc or disc or disc ❑ 0-rings [] 0-rings ❑ 0-rings ❑ Seat ❑ Seat 0 Seat ❑ Spring ❑ Spring ❑ Spring ❑ StemiGuide ❑ Diaphragm(s) ❑'Stem/Guide ❑ Other, specify: ❑ Other,specify. . ❑ Other, specify: ❑ Other, specify: [] Other,specify: ❑ Other, specify.' Finaltte�t after repairs: Opened at: _ Final test: Final test. -- psi __..._—_..- psi __.___- psi —, psi _— Comment`___..,...._. .. ..-__..____. _.-- I he rc.by ccrtily that this date is aamiriatc and reflects the proper operation and maintenance of the assembly, Tester's Name: L etee _/Lk G`-., License#-Ccrllficalic5n if �freJCy3d/� ., ltslc r', Sly nat Lr -.- _-. .„._._...__._ oate: ._. � � ._•__,_...._-_—. •