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HomeMy WebLinkAboutRPZ Test 4/8/2011 RPZ Annual Test Report Reduced Pressure Zone / Double Check Valve Backflow Preventers Name of Facility: 140L 1) AI _s wxrurvo singE Facility Address: i -kt,bo cW- puv,,-wA,w 1.1.Aus (Dq-- Street pit, c. City State County Location in Bldg.: _ ,_ _ 0 . u _ . [ ., "l M ` ev6K s System Protected: 0 etQup. - COLO Make: VI tl..A4 l,vS Model: - lc ?c L- Size: a Serial #: /e46. 1 . .F.F Notes: 1 JG XT Qi/t= Q/dv4 -v (. 0 ,,,F . am m ip Check Valve #1 Check Valve #2 Relief Valve (RPZ only) Initial Test Leaks ( ) Leaks ( ) Opened At ( ) Psi Pressure Diff. Closed Tight ( ) Closed Tight ( ) Relief Valve Did Not Open ( ) Repairs Cleaned ( ) Cleaned ( ) Cleaned ( ) Replaced ( ) Replaced ( ) Replaced ( ) Disc ( ) Disc ( ) Disc Assembly ( ) Disc Holder ( ) Disc Holder ( ) 0 - Rings ( ) Stem ( ) Stem ( ) Stem ( ) Retainer ( ) Retainer ( ) Spring ( ) 0 - Rings ( ) 0 - Rings ( ) Diaphragm ( ) Seat ( ) Seat ( ) Seat ( ) Spring ( ) Spring ( ) Spacer ( ) Guide ( ) Guide ( ) ( ) Bushings ( ) Bushings ( ) ( ) Other ( ) Other ( ) Other ( ) Describe: Describe: Describe: OUGe.-“avi due 4.A -ut. ®uuil( L Final Test Closed Tight to (x) Closed Tight (X) Opened At (a ,T) Psi Pressure Diff. Technician Info Name Certification No. Signature Date — Initial Test by: Repairs by: jM i ice tock,vt4.4„, ocoggl (o gp -��; ``-- '7( // Final Test by: Testing Company: Mid -City Mechanical Corporation 9103 Davenport St. Ne. * Blaine, Mn. 55449 * ph. 763.786.8617 fx. 763.786.8640 RPZ Annual Test Report Reduced Pressure Zone / Double Check Valve Backflow Preventers Name of Facility: - / Li DAB , As C - l — ft.., Facility Address: 4 /(cO Fcx.. ?I _ ><t-ILLS Pr. _ a ee. 2w2 L4. -)44= (m.„ , City State County Location in Bldg.: ( 44 cg QQ, „ p. M i S 6E - lrvG System Protected: ( �, A Ep v ip . Make: W 1 Model: ' xL Size: ft Serial 4: ['30(0(20 Notes: (9 veE (AAA.)( 0 rkP "a Check Valve #1 Check Valve #2 Relief Valve (RPZ only) Initial Test Leaks ( ) Leaks ( ) Opened At ( ) Psi Pressure Diff. Closed Tight ( ) Closed Tight ( ) Relief Valve Did Not Open ( ) Repairs Cleaned ( ) Cleaned ( ) Cleaned ( ) Replaced ( ) Replaced ( ) Replaced (X ) Disc (x ) Disc ( c ) Disc Assembly ( x ) Disc Holder ( ) Disc Holder ( ) 0 - Rings ( x ) Stem ( ) Stem ( ) Stem ( ) Retainer ( ) Retainer ( ) Spring (c ) 0 - Rings Oc) 0 - Rings (/c) Diaphragm (x ) Seat ( ) Seat ( ) Seat ( ) Spring (X) Spring (X) Spacer ( ) Guide ( ) Guide ( ) ( ) Bushings ( ) . Bushings ( ) ( ) Other (K) Other 0e) Other (K) Describe: Cite RA 1.- Describe: O JG a N,AJt_ Describe tuce- -o Final Test Closed Tight 9.8 (X) Closed Tight (X) Opened At (3. •-) Psi Pressure Diff. Technician Info Name Certification No. Signature Date Initial 'Pest by: Repairs by: M I IKE Gant a.,, C7(vY et fv KF -0,-�'a _ ."-- 4 / , F fir' Final Test by: Testing Company: Mid -City Mechanical Corporation 9103 Davenport St. Ne. * Blaine, M1ln. 5:,449 * ph. 763.786.8617 fx. 763.786.8640