HomeMy WebLinkAboutRPZ TEST 8/30/2010 FROM (TUE� 2 8 2d11 12:23/8T.72:21INa.800173T369 P 5
Metro Testing
31222 Cedar Creek Road
Hinckley, MN 55Q37
G12-221-58$8
"�' $ackflow Preventer Test 12epart
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Ow�er: �� ��� Contact Personi Tet. Date:
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Address: City: %ip:
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Make: �� 1Y�ode1: � � � Si�e: ���� Serial: ����
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Loc�tioa of Device: Setwes what System:
i�o fG'�. �Sy+°� i�o. !L ��
Test Year Check Val�ve #1 Check Valve #2 �1►ifferenla�l Pres. Relief
Leaked( ) Leaked( ) Did Not Upen
�"� Closcd (p� �Q Closed {p�
� � �
� Pressure 0•� Pressure �. � O ened At
Cleaned Cleaned � Cleaned
� it.eplacer� Replaced X2epiaced
Poppet Pappet Dtaphr��m
E Spring Spring Spring
p O]ting 4 Rin� O Ring
A Rub6er Seat � Rnbber Seat �tubber seat
Other Repairs • Other Rep�irs Uther Repairs
X
R
S
Certificat�on
I hereby certify the faregoing data to be correct a that the devic tested is functioning
'VVithia the lxm�ts af the standards signec�: ..,. �. �
Firm Name: Metro Testin� 31222 Cedar Creek Rd. Hiucktev, MN 55037
'1'�s#ed By: Gary Fo�rd Certi�cat�on # 058476-BF OR �oIe Ford Certi�eation # 6ti445-BT
' This report is for the purposes/Recordzng only; Uumer is responsible £or saf� aperation
And u ke pf scheduied maintenance.
FROM fTUE� 2 8 2011 12;2318T.72:21INo.SO0yT3T3B9 P B
Metro Testing
31222 Cedar Creek Road
�inckley, MN �50�7
G12-221-5885
Backflow Preventer Test Report
'ST�„1cab� `'�E,rr aTa�
����t': Contact Pe�rson/ Tel. D�te:
�sa `7�`� ��o• fb
Ac�dr�s; p. �
City: Zi .
:�' �CJ �'�, t"�c�� , ,�„ ��s 2. e C�.r1 k�.
Make: Modet: Size: �(�« Serial: �,�1dT i�'7
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Locatian of Tfevice: Serves what System:
�t1� ��cs��t� ar✓1 � j ���I�Z
Test Year Check Valve #1 Check Valve #f2 Di�fe�-ential Pres. Relie.f
I � 7 � Leaked( ) Leaked( ) Did Not Open
� �� Closed �j�tj. � � Closec� �
Pressure • Pressare �.� O ened At ,�. �
Cleaned Cleaned CZeaned
R Replaced Repiaced Replaced
Poppet Poppet DiapLragm
E Sp�ai�ag Spring Sprin�
� O Ring O Rin� O Ring
A Rubber Seat Rubber Seat Rubber seat
Other Repairs U#her Repairs Other Repairs
� �
R
S
Certi�ication �
� hereby certify the foregoing clata to be correct and that th device,�tested is functioning
Within the limits of the standards signed:,_,. _ �,,.._..._
�'irw Name; Metro Tes ' 31.22,2 Cedar Creek Rd. Hi ckle 55Q37
Tested By: Gary Forc! Certification # 058476-BF OR Cole Ford Certificatir�,n # 66445-BT
This repart is for the purpose.s/R.ecording only; ()wner is responsible for sa.�e operation
And u ke of scheduled maintenance.