HomeMy WebLinkAboutRPZ TEST REPORT 9/12/2011 • I `, „,, I ,
... . METRaris_T ANICA� LLC.
E -Mail: MetroTesting.LLC @Gmail.com
Visit us at: www.RPZtesting.com1www.MetroTesting.net
Reduced Pressure Zone Backflow Preventer Valve & Pressure Vacuum Breaker Valve
Rebuild / Test Report
Business: Contact Person Tel: Date:
HOLIDAY STATION # 198 9/12/2011
Address: C i tv- / i p
16800 DULUTH AVENUE PRIOR LAKE 55372
Make: Model: Size: Serial #:
WILKINS 975X1 1 Y2 519 563
Device Location: Served what System:
CARWASH MECHANICAL ROOM CARWASH
Install Yr: Rebuild Date
N/A 9/20122017
(Every 5 Yr. is required to be Overhauled/Rebuilt, MN Adagio Rule: 4715.2161.)
Test Yr. Check Valve # 1 Check Valve # 2 Differential Pressure Relief
(Circle One) Leaked( ) Closed (- Leaked( ) Closed ('74., Did Not Open( )
1 2 3 6
Overhauled ( ) Pressure: g. 0 Pressure: � Opened At: J s
R Cleaned Cleaned Cleaned
E Replaced Replaced Replaced
P Poppet Poppet Poppet
A Spring Spring Spring
I
0 Ring 0 Ring 0 Ring
R Rubber Seat Rubber Seat Rubber Seat
S Other Repairs Other Repairs Other Repairs
Certification
I hereby certify the foregoing data to be correct and that the device is tested is functioning within the limits of the standards.
Signed: a � t Dated: q-0.--1 1
Tested by : GARY FORD Certification # 058476 - BF or COLE FORD Certification # 066445 -
Fi rm Name: Metro Testing/ Metro Mechanical Consultants, LLC Address: 31222 Cedar Creek Rd, Hinckley, MN 55037
$ This report is for the purposes: Recording Only; Owner is responsible for safe operation and upkeep if scheduled maintenance.
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