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HomeMy WebLinkAboutRPZ TEST 8/30/2010 FRQM fTUE� 2 S 2611 ♦2:2418T.12:27JNo.800173T389 P 8 N.[etro '�'esting 31222 Cedar Creek Road � Hinckley, M� 5�037 612-221.-5$88 —�~ Backflow Preventer Test Iteport V t�•i �f�•� t��,ra�j � ` �� �. Ow�er: ,,,..,. Cantact Pexson/ Tel. Date: ..1s.5 � �!� $' '�►t3' t () Address: Zi City: p: f�'�t� �F�� ��� a � ��, a� �. �,��.. Make: Model: Size: .� Seri�►1: ZJ�►�z �ca°�,��. � �4 r� r t b� Loe�tia� of Device: Serves what System: t �hi,�.$� �t�� �j,�,':T.a(��T�r�ra Te�t Year Check Valve #1 Check Valve #2 Differenti�.l Pres. Relief �� Leaked{ ) Leaked( ) Did Not Open � f .-- � Closed �L�„ Closed (�} `�' Pressure ��� Pressure � • � Q ened At •�_ � Cleaned Cleaned Cleaned � Repl�ced Replaced Replaced poppet Poppet Dia.phr�tgm � Spring Spring Spring p o �� o ��g o ��� � Rubber Seat Rubber Seat Rrabber seat Other Repafrs t�t�er �,2.epairs Other Repairs � R S Certifca�Eion I hereby certi�y the £oregoivag data to be carrect suc�{�t a.t t.�e 'ce t d is functioning Withut the limits af t�e standards signed: `�� c I+'irm Name: Metra Testin� 31222 Cedar Creek Rd. Hincklev. SS037 Tested By: Gary Ford Certification # 058476-BF OR Cnle Fard Cer#i�catinn # 6C►44S-BT ' This report is for the purposeslRecording anly; Owner is respansibie £or safe operation And u kee af schcduled maintenance. FROM CTUE) 2 8 20Y1 72:241ST_�2:21fNo.$00�73T3B3 P 9 Metro Testing 31222 Cedar Creek Road Hinci�ley, MN 55037 f 12-221-585� ,,,,...�--- IIackflow Prevez�ter Test Report �,��r" �c�� ���.r�,GJ'174,z Ownter: � �� Contact Person/ Tel. l)ate: �. ,,; �^ t � Address: City: Zip: !'�180U f.�'��5 s� r��-� r�Ez. j� r d� Make: Model: Size: r� " Serial: ,�1�a�s �.�� � 3 ��Ib Location of Device . Serves �vhat System �� �rr�. S t°b ' Test Year Check Valve #1 Check Valve #2 Differential Pres. Relief T � E Lcaked( ) Leaked( ) id Not Upen ,� J ,.,, Closed �. W ,.�' ,,, Closed (o� �,,.--+ „� ��� � pressure t`� "� � Pre�s�re t'�� � Cl e d At Cleaned Cle�ned eaned R Replaced Replaced R lace kappet Poppet Ui� h gm E Spriung Spring Spri p O Ring O Ring O' A Rubber Seat • Rubber Seat , Ru ber at 4ther Repairs Other Repairs Uther pairs � �. � Certificat�c�n I hereby Ce�rt�:f� the faregaing da#a ta be correct, �nd that the devic+e tested �s funct3oning Within the limits af the standards signed: �� �.='�'�„-_....._„� Fiarm �Tame: esti 3122 eda e R. Hinc MN S 037 Tested By: Gary Ford Certificatian # OS8476-BF OR Cole Ford Certification # 66445-BT This report is for the purposes/Recording only; Qwner is responsible �for safe o�eration And u kee of scheduled maintenance. FROM CTV6T 2 8 20Y1 12:2415T.�2:21lNo.800173T369 P 70 Metro Testing 31222 Cedar Creek Road �Iinckley, MN 55037 612-221-5888 � k3ackflc�w Preventer Test Report �".� ' f Ownert Cont ct Person/ Tel. Date: �' � 0« �� �� e Aadx�s�: • '�� �irr' �+4�5 ra� � t2►�#�, � Zip. Make: Mode1: Size: r Sex`ial: "�-! l�a?F�► �C� 'S� � 1� W J`l �O(� Loca#ion of Device: Serves what System: l�r ��i� .�� i3�r � '�,�N� Test Year Check Valve #1 Check Vaive #2 'ffereutial Pres. Re ' .�� Leaked( ) Leaked( ) Di ot Open � �,� Closed (� � Closed � �,,-'° � � �s r'' Pressure �+�,,,�.� Pressure ����� Q �ne A , Cleaned Cleaned Cle ed � R R��f1aECCCI Re�'11AC�(� R 1 f�(� Poppet Foppe� aph gm � Spring Spring pring p o Ring a Rimg rting A Rnbber Seat Rubber Seat ubber s# Other Repairs Other Repairs 4ther epairs � R S � Certif cation . I hereby certify the faregoing data to be correct a�l that tbe device tested is fe�nctioning Wit�ia tbe �imits o�'the �tandards si�gned: �rati. -��-2.� Firm Name: Metro Te.qtin� 31222 Cedar Creek Rd. Hincklev, 55037 Tested By: Gary Furd Certi�catian # Q584'7G-BF 4R Cole �'�nrd Certa�ca#ion # 66445-8'T This report is for the purposes/Recordir�� only; Owner is responsible for safe operation And u kee of scheduled maintenance.