HomeMy WebLinkAboutRPZ 8/9/2011 (2) Page 23 of 23
M TESTI NG ,
ETR OMECHANICAL LLC.
E -Mail: MetroTesting.LLC @Gmail.com
Visit us at: www.RPZtesting.com I www.MetroTesting.net
Reduced Pressure Zone Backflow Preventer Valve & Pressure Vacuum Breaker Valve
Rebuild / Test Report
2.2
Business; !VW LaW SChookk ISQ 1 714 Contact Pecs'' tot: 1112 .i*i
WE OCD GARY DELLiNtt: 9M1 I
Ott) 9 490 fr
Address: City: Zip:
5370 WESTWOOD DRIVE PRIOR LAKE 55372
Make: WATTS I Model: 909QT I Size: % 1 Serial #: 411484
Device Location: Served what System:
SMALL BOILER ROOM, BY CUSTODIAN RM. BOILERS
Install Yr: Rebuild Date:
NIA 8I 2006
(Every ? Yr. is required to be Overhauled/Rebuilt, MN Morin Rule: 4715.2161.)
Test Yr. Check Valve # I Check Valve # 2 Differential Pressure Relief
(Circle o') Leaked( ) Closed - Leaked( ) Closed (X) Did Not Open( )
1 2 3 4
Overhauled ( 4 Pressure: (• b Pressure: 7 ' Opened At: 3
Cleaned Cleaned Cleaned
Replaced Replaced Replaced
P Poppet Poppet Poppet
A Spring Spring Spring
I O Ring O Ring O Ring
R Rubber Seat Rubber Seat Rubber Seat
s Other Repairs Other Repairs Other Repairs
Certification
I hereby certify the foreg • g be correct and that the device is tested is functioning within the limits of the standards.
q
Signed: Dated: ! - .90 1/
Test by : GARY FORD Certification # 058476 -BF or COLE FORD Certification # 066445 -BF
F i rm N ame : Metro Testing/ Metro Mechanical Consultants, LLC Add re s s : 31222 Cedar Creek Rd, Hinckley, MN 55037
%J,s,II,..,e,.I/ / / / / / / / / ,.v//S,O,0,.I/.MIP,�/IV,.Y / / / / / ,O/4I,ARs,I/a///,VII.//// / / / / ////, /r.�.I/ / , / / ,I/.fIF.!/O/II,N .I,.d y. 6// /NY.d.Y/d%/I///I/IN.U.G/Y/Y11/4144
,! This report is for the purposes: Recording Only; Owner Ls responsible for safe operation and upkeep if scheduled maintenance. / ;
7.. / / / , ' / / / / / / / /I/.I/I/I.I /I% / / / / , / / /4 , / / / / / / / I, I, I/ I, I, I, I, I, I. I. I. I. I�I7// INI. IVIVS. I. I. I. I. I/ I/ I. I/ I/ I /I/I/I.I,IMMI/I/I'I/I.I /I.I /I/J
kl f r o va(✓ jai .- rtS
..,..,/20„