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HomeMy WebLinkAboutRPZ Backflow Test Report 5.28.15 CORVAL GROUP-'. 401 1633 Eustis Street, St Paul, Minnesota 55108-1219 (651)645-0451 Fax: (651)642-5591 An Affirmative Action, Equal Opportunity Employer TO: YMCA of the Greater Twin Cities DATE: 5/28/15 ATTN: Brian Skunberg PROJECT: RPZ Testing 3575 N Berens Rd NW LOCATION: 3575 N Berens Rd NW Prior Lake, MN 55379 OUR PROJECT NO.: 4010 WE ARE SENDING YOU: ®Attached ❑Change Order ❑Specifications ❑Shop Drawings ❑Under Separate Cover ['Copy of Letter ❑Prints ❑Request for Change ❑Thru Messenger ['Plans ['Samples ❑Purchase Order No.__ #`a 1 1 Backflow Preventer Test Report for Serial#W4057605 3 TRANSMITTAL CODES: 1. For Acknowledgment 6. Approved as Submitted 2. For Approval 7. Approved as Noted 3. For Your Use 8. Rest oval 4. As Requested 9. ReleaseubmiforCopies productionforAppras per delivery date indicated on our Purchase Order 5. For Review and Comment 10.Furnish changes in contract price, if affected,by 11. Other: REMARKS: Replaced sn#W245504 Copy To: 1. Project Manager File 2. Follow-up File Corval Group, Inc. City of Prior Lake CORVAL GROUP' BACKFLOW PREVENTER TEST REPORT DATE: • Site Name: Yl , gofer- 1411/ Job# . _ Site Address: 3 5 73 1\1°(11A Aci, City: Prtn • Zip Code: 653-g Contact: ._Qty ku'ii Phone#: _ Owner: �rn 1, : Phone#: Owner Address: catNYIQ City: Zip Code: _ Make/Model of Device: ' k45 5X( Size: Serial#: 4/05 j Serves What System: Poo(/Pot r �. Location: RI R(D©(,t/ Ck Valve Pres. Dif. Across Pres. Dif. when Ck Valve#1 #2 #1 Ck relief opens Strainer _ Leaked ( ) Leaked ( ) None ( ) Test before Repair Close ( ) Close ( ) PSI PSI Clnd ( ) - Describe Repair _ Final Test Materials Leaked ( ) Leaked ( ) s None ( . Used Close (K) Close (X) ‘C)PSI S,CPSI Clnd ( ) _ • CERTIFICATION: I hereby certify the foregoing data to be correct and that the tested device is functioning within the limits of the standards. FIRM NAME: Corval Constructors, Inc. ADDRESS: 1633 Eustis Street St. Paul MN 55108 : B (atej - `rf� ' CERTIFICATION#: Q9 356 ( PHONE: 651-645-0451 DATE: 036-5- REMARKS: F GJt,S O�4 �/{I kc J 773 )(L ccvi : OZ 5,5-011 (X INSTALL () TEST ()REBUILD ORIGINAL INSTALLATION DATE: DATE OF LAST REBUILD: