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HomeMy WebLinkAboutRPZ TEST (2) TEST AND MAINTENANCE REPORT FORM RPZ - Reduced Pressure Zone Assemblv - RPZ .; 3415 SPRING GL YN, PRIOR LAKE GLE:N WATER WEST Date: tv10del Serial# W 150568 Address: Owner: Make WI 975XL INITIAL TEST OF DEVICE: Size 2 Check Valve #1 Leaked [ ] Closed L~ Pres. Dif#1 Check ---1, f PSI Pres Dif Relief Opens t.-', / PSI Strainer: None [] Cleaned [ ] I Check Valve #2 Leaked [ ] Closed ~ PSI {, 1 I MAINTENANCE OF DEVICE: Check Valve #1 Check Valve #2 Cleaned: Cleaned: Repaired: Repaired: CHANGED OR NE~W DEVICE INSTALLED: Date: / / --- Device Type: Model: Manufacturer: Serial No.: Size: FINAL TEST: Check Valve #1 Leaked [ ] Closed [ ] Pres. Dif #1 Check: ~}/ PSI Pres Dif Relief Opens ! - /1 PSI Strainer: None (^- Cleaned [ ] Comments: '7 U p ) ./ ~~~- ./ p/J/ . Signature of Certified Tester Testing Company: Testers Cert. Number: cf lj /i :r -r- Westman Plumbing 31569 Nuthatch Avenue Aitkin, MN 56431 (612)-701-4789