HomeMy WebLinkAboutRPZ Test 5/3/2007
~PRO
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Don1 Call a CowtJoy, Call a Pro
PLUMBING. SEWER &
DRAIN CLEANING
Res/dent/ol & CommerCial
952-890-4455 · 651-452-9888
952-469-6999 · 1-507-663-1765
24149 Highview Avenue. Lakeville, MN 55044
Customer:
Mailing Address:
Property Owner:
Street Address:
Mailing Address:
Location of Assembly:
ANNUAL TEST - BACKFLOW PREVENTORS
Jo..~.,,, <or~
L\ CJ q '-\ ~ rOO . \'\ i.J.fI\. ~ \ \J VY { '\ 0 r '- ~ ~-t'
t11,tV.
TYPE OF ASSEMBLY
MANUFACTURER:
w.,."';)~ <;~ ~~
~PZ
t-<~CO
DDCV
MODEL:
Relief Valve
Opened at:
'). c,s psi
did not open gj
Check Valve #2
Back Pressure
Test
Leaked D
Closed Tight ~
Check Valve #1
In Direction of
Flow Test
Leaked D
Closed tightg
Differential pressure
across chef(k valve
<1.0 psi
Cleaned only 0 Cleaned only 0 Cleaned only 0
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
Opened at:
psi
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
Closed Tight 0
Opened shut off #1 EI-
Remarks:
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
~tJ...~-r.
DPVB
[]SVB SIZE:
SERIAL #:
Check Valve #2
In Direction of
Flow Test
Leaked D
Closed tight g
Differential pressure
across check valve
\ ,c:;( psi
Cleaned only 0
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
Pressure
Vacuum
Breaker
Air inlet
opened at:
Did not open
check valve: D
Leaked 0
held at psi
I \'
Spill-Resistant
Vacuum
Breaker
Air inlet started
opening at:
psi
Did not open
check valve: D
Leaked 0
held at_psi
Cleaned only 0 Cleaned only 0
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
Air inlet
psi
Check valve
psi
Opened shut off #2~ Water Pressure '/<r Test Kit Serial #
Differential pressure
across check valve
psi
Differential pressure
across check valve
psi
Replaced:
Rubber Kit
Assembly
(RV)
Disc
Diaphragm
Seat
Spring
Guide
O-rings
Other
Air inlet starting
to open
psi
Check valve
psi
I hereby certify that this date is accurate and reflects the proper operation and maintenance of the assembly,
Tester's Name (Print) ,J~cJ C! 0 EF- Cert. - tJ L.'-j
Tester's Signature (. Date 5/y LJ 7 Time