HomeMy WebLinkAboutRPZ TEST 9/30/2010 FROM CTUE) 2 8 20tiy 12:22/$T.�2:21IMo.SO0YT3T36S P 2
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Metro Testin�
31�22 Cedar Creek 12.oad
Hinctzley, MN 55037
fi12-221-5888
Backflov�r Pre�venter Test Report
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C3wner. � 1 Contact Person/ Tej. Date: .�� /�
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Address: ,,. City: Zip:
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Make; � Model: � � ,�� Siz�: ,, Seriax:
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Lo�atian of Device: Serves what System:
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Test Ye�r Check Valv� #1 Check Valve #2 Differenrial Pres. Relief
Leaked( ) Leaked( ) Did Not Open
�� ��� Closed (�- �� Ciosec� �. � .
~ L Pressure �' � � _____ Pressure I, k► Q ened At
Cleaned Cteaned Cleaned
R Repla�ed Replaced � Replaced
Poppet Foppet Diaphragm
� Spriung Spring Spring
p O Ring O Iti�g 4 Ring
� � Rnbber Seat Rubber Seat Rnbber seat
Clther Repairs Other Repairs Other Repairs
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Certi�iication
,� hexeby certify tlae faregaing dat� to be correct aud that the vice Ee, ed is functionin�
With�n #he limits of the standards signad: a
Firm Name: Metro Testing,�31222 Cedar Creek Rd. Hincklev, 5503'7
Tested By: Gary Ford Certi�cation # U584�b-BF OR Cole Ford Certificatian # 6b44�-BT
� 'T'his report is far the purposes/Recording anly; Owner is responsible for safe operatian.
And u kee nf scheduled maintenance.
FROM fTUE> 2 8 2011 12:231ST.12:21fNo.800�73T363 P 3
Metro Tes�ing
3].222 Cedar Cr+eek Road �
Hinekley, MN 55037
G12-221-5888
Backflaw Freventer Test Report
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� Uwner: � �,� Contact Person/ Tet. Date. ,��� !�
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Address: ,, � City: 2�p:
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Make. ModeL• Size: �/� °� Serial: �� $�, t �,�
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Locati+�n of Dev�ce; Serves what System:
��w��. o .l�.�, ;�a�1��..5
Test Year Check Valve #1 Check Valve #2 Differential Pres. Reiief
� Leaked( ) Leaked( ) Did Not Upen
,(,,,� �t. Closeci (�,,1 � � �losed {�, r� �
� Pressure • Pressure � O ened At �• `�
Cleaned Clea�ned Cieaned
� - Replaced R�placed � Replaced
• Poppet Poppet Diaphrag.m
� �pring Spriun�g Spring
p O Ring O Ring {� Ring
� Rubber Seat Rubber Seat RnbUer seat
Other Repairs f3thcr Re�aKrs 4ther Repairs
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S
Certification �
I hereby certi�y the faregoang data to be cor�rect a� that t� device sted is functioning
'Within th+e li�nits of the st�►rndards signed:_�,�,,. r„�,,,�,,,,,_____
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Firna. Naane: M�atro Testing 31222 Cedar Creek Rd. Hincklev, 55037
Tested By: Gary Ford Certific�tion # OS8476-BF OR Cote Fr►rd Certi�cation # 66445-B'�'
This report is for the pwrpnses/Recording only; Owner is responsible for safa operatian
And u ke of sch�duled mainienance.
FROM (TUE) 2 8 2071 72:231ST.72:21IMo.800173T389 P 4
Metro Testing
31222 Cedar Creek Road
Hinckley, Mi�155Q37
612-221-5888
BackIlow Preventer Test Report
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Owner: Cantact �'erson/ Tel. D��:
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Address; �,,.,. Cih': r�*, Zip:
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Make: + f_ '� Mudel: � S7ize: �, Serial;
J'� � d 3
Location o�'Device: Serves v�hat System•
i�, ��.;z.,. ?.�o�, � � . I �: �.
Test Year Check `Valve #1 Check Valve #2 Differential P�res. Relief
,� � Leaked( ) Leaked( ) Did Not Open
C� �^ � � Ciosed (� /� p, Closed (�
Pressure t� .► Pr�essure �,� U ened At �• �
Cle�ned Cleanecl Cleaned
R Replaced Replaced Replaced
� Poppet Poppet Diaphragm
� 5���+g Spriug Spriutg
p o xing o Ring a► li;w►g
� Rubber Seat Rubber Seat Rubber seat
Other Repairs� __ _____ . (}ther x2epairs Other Repairs
�
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S
Ce�rtification
I hereby ce�rtify the faregoiz�g data to be correct a d that the devic tested is fuuctinning
Withiu the limits af the star�dards signed: � c `
i+`�ir�► Name: Me�ro Testin��3,1222 Cedar Creek Rd Hincklev. 55037
Testec� By. Gary Ford Certificatian # OS8476-BF OR Cule �"ord Cer#ificatian # 66445-BT
This reporC is for the purposes/Recording only; f3wner is responsible for safe operation
.Aaad u ke af scheduled maintenauce.