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HomeMy WebLinkAboutRPZ Test 5/15/2007 TEST AND MAINTENANCE REPORT FORM RPZ - Reduced Pressure Zone Assembly - RPZ Address: Owner: Make 3304 GLEN WATER TRAIL, PRIOR LAKE GLEN WATER WEST Date: S- - I ("" - 0 ) WILK Model 975XL Serial# 1063061 Size 2 INITIAL TEST OF DEVICE: Cheek Valve #1 Leaked [ ) Closed rt.l Pres. Dif #1 Check: Pi ( PSI Pres Dif Relief Opens J. 1- PSI Strainer: None [~ Cleaned [ ] I Check Valve #2 MAINTENANCE OF DEVICE: Leaked [ ) Closed ~ PSI I Cheek Valve #1 Check Valve #2 Cleaned: Cleaned: Repaired: Repaired: CHANGED OR NEW DEVICE INSTALLED: Date: _1_1 Device Type: Model: Manufacturer: Serial No.: Size: FINAL TEST: Check Valve #1 Pres. Dif #1 Cheek: Strainer: None [ ) Leaked [ ) Closed [ ) PSI Pres Dif Relief Opens Cleaned [ ) PSI Comments: j{ J ) "" , r -/J: /~ s(gnature of Certified Tester 't'oV Testine: Comoany: Testers Cert. Number: (j 'if I T Westman Plumbing 31569 Nuthatch Avenue Aitkin, MN 56431 (612)-701-4789